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Change Here!Managing Change to Improve Local Services

ChangeHere (covers).qxd 28/06/2001 15:29 Page 3

The Audit Commission promotes the best use of public money

by ensuring the proper stewardship of public finances and by

helping those responsible for public services to achieve

economy, efficiency and effectiveness.

The Commission was established in 1983 to appoint and

regulate the external auditors of local authorities in England

and Wales. In 1990 its role was extended to include the NHS. In

April 2000, the Commission was given additional responsibility

for carrying out best value inspections of certain local

government services and functions. Today its remit covers more

than 13,000 bodies which between them spend nearly £100

billion of public money annually. The Commission operates

independently and derives most of its income from the fees

charged to audited bodies.

Auditors are appointed from District Audit and private

accountancy firms to monitor public expenditure. Auditors

were first appointed in the 1840s to inspect the accounts of

authorities administering the Poor Law. Audits ensured that

safeguards were in place against fraud and corruption and that

local rates were being used for the purposes intended. These

founding principles remain as relevant today as they were 150

years ago.

Public funds need to be used wisely as well as in accordance

with the law, so today’s auditors have to assess expenditure not

just for probity and regularity, but also for value for money. The

Commission’s value-for-money studies examine public services

objectively, often from the users’ perspective. Its findings and

recommendations are communicated through a wide range of

publications and events.

For more information on the work of the Commission, please

contact: Sir Andrew Foster, Controller, The Audit Commission,

1 Vincent Square, London SW1P 2PN, Tel: 020 7828 1212

Website: www.audit-commission.gov.uk


Change Here!Managing Change to Improve Local Services

ChangeHere.qxd 28/06/2001 10:18 Page 1

© Audit Commission 2001

First published in July 2001 by the Audit Commission for Local

Authorities and the National Health Service in England and Wales,

1 Vincent Square, London SW1P 2PN

Printed in the UK for the Audit Commission by Holbrooks Printers Ltd

Photograph of Euston station, London: Milepost 92½


Contents

Overview

1. IntroductionContext – The purpose of this paper – Four types of change – Key points

2. Role of the leadership teamLeading change – The four leadership roles – Key points

3. Local ownershipBuilding support for change – The role of good practice – Communication – Key points

4. Sustaining focus on the key prioritiesDoing less to achieve more – The change curve – Key points

5. Focus on usersUnderstanding users – Involving users – Measuring what matters to users – Key points

6. Managing the change programmeProject management – The balanced scorecard – Key points

7. Using external helpMaking the best use of ‘outsiders’ – The role of regulation –

Professional advice and support for change – Key points

8. Building capacity for continuous improvementAiming for change-friendliness – Modernising infrastructure – Developing people –

Incentive systems – Key points

9. Conclusion

Appendix

References

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Overview

Public services face huge challenges, if they are to deliver the

improvements that users expect. During its first term, the Government

put in place a range of reforms intended to stimulate improvement in

services across central and local government, and in the NHS. More

reform is promised for the second term. This makes change

management one of the key skills needed by leaders of public services.

At the Commission, we have learned a great deal about both the

opportunities and the challenges of managing change effectively,

through our work with local public service bodies. This paper seeks to

distil that learning, as well as drawing on the insights of successful

leaders of change, to help public service managers to rise to the

challenge of delivering continuous improvement for service users.

It is only by focusing on users’ experience that public services can deliver

improvements that are relevant and add public value. This means that

successful change programmes must begin and end with an

understanding of what matters to users.

Change initiatives must be ‘bespoke tailored’ by local organisations to

tackle the problems facing their communities, if change is to be ‘owned’

locally by the public and by their own staff. This does not mean

accepting variations in performance that compromise service outcomes.

Communities everywhere expect the same high standards of health,

education, and policing, provided by the best performers. However, it

does mean that change cannot be driven from the centre alone. The

Government must give local service providers the flexibility to respond

to local demands. In return, public service bodies must deliver excellent

services that match the standards of the best.

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Achieving the transformational change that leads to excellence

demands a relentless focus on a small number of key priorities, as well

as commitment by public service bodies to maintain this focus through

the inevitable highs and lows of the change process. The Government

can support this focus by setting out clearly its priorities for

improvement, and giving local public service bodies the space and

freedoms to deliver them.

Above all, leaders of local public services play a crucial role in

maintaining a commitment to major change initiatives, by mobilising

and sustaining support for change among staff and local stakeholders.

By setting out a clear vision, and investing in effective ways to

communicate this to staff, leaders can keep their organisations on track

through the change journey.

Delivering positive change and continuous service improvement is the

biggest challenge facing public services. Managers and non-executives

also face a major task in balancing national priorities alongside the

concerns of local communities.

At the Commission, we will continue to support local services in their

drive to achieve excellence. But it is public service leaders, above all else,

who can make this step-change happen. By providing a clear sense of

purpose, and inspiring the commitment of staff, public services can be

transformed. We look forward to working with you to achieve this

shared ambition.

Sir Andrew Foster

Controller

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1. IntroductionContext

The purpose of this paper

Four types of change

Key points

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ContextAs we move into the 21st century, the public sector is faced with the

challenge to improve the service it delivers to its customers. Over the

past decade or so, most of us have experienced sizeable leaps in the

quality, choice and accessibility of services we take for granted as part

of our daily lives. But a gap has opened up between what commercial

services can deliver and what we can expect from public services. For

example, two-thirds of the people in this country now own mobile

telephones and the cost of calls has fallen by nearly one-quarter over

the past two years. We can buy cheap fresh food from around the world

at any time of the day or night at a local supermarket or, if we prefer,

over the phone or pc, to minimise interruption to the 40 or so television

channels transmitted into our homes. Meanwhile, it is still difficult to

find a public library open before or after work or at any time on

Sundays, and GP surgery hours are similarly limited. This may be

acceptable to the generation that remembers the hardship of life

without decent public services. But for increasing numbers of us today,

despite the effort and commitment of public service workers, the

widening gulf between what we can buy as customers and what we get

as public service users has created a credibility gap. As a result, many

have become alienated from the political process and disaffected with

public services in general.

This is not to dismiss the progress that public services have made,

nor the talent and commitment of staff, managers and leaders. Charged

with meeting multiple objectives, public services face greater challenges

and have more restricted resources than is fairly reflected by a straight

comparison with industry. Moreover, the public sector must serve all

sections of society, not just those with money in their pockets. During

the past 30 years, attitudes to public services have evolved from a

paternalistic assumption that the state will provide, through stringent

public spending restraint and wholesale privatisation, to the current

philosophy that accepts an underlying societal responsibility for good

public services but increasingly expects empowered individuals to take

responsibility for themselves. This reality is full of contradictions:

between local autonomy and central control, between consumer

expectations and the capacity of services that have been starved of

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investment, between what people say they want and what they are

prepared to pay for.

As services fall short of public and political expectation, the

modernisation agenda calls for significant improvement in performance

throughout the public sector [EXHIBIT 1, overleaf]. Best value in local

government is being matched by a plethora of initiatives within the

NHS Plan.I But experienced managers know that delivering tangible

change on the ground goes well beyond policymaking. Nor is it

primarily about structural reorganisation, which can be simultaneously

energy-sapping and irrelevant to the primary task of improving services.

Change is not a simple, linear process, and numerous examples illustrate

how difficult it is to achieve sustained improvement in public services

[CASE STUDY 1, overleaf]. Improving the experience of users, patients and

their families requires not only changes to systems and procedures in

what are often huge, complex and interdependent organisations, but

also, crucially, changes to the attitudes and behaviour of individual

members of staff. Change is painful and destructive as well as positive

and creative. It challenges vested interests: personal, professional and

institutional. Change is unavoidable; potentially both exciting and

rewarding, but at the same time a messy and difficult enterprise,

frequently confounding the intentions of managers, politicians and

policymakers.

All around us, public service leaders are struggling with conflicting

demands and unrealistic expectations from politicians, the public and

within their own organisations. There is no magic formula for change

management, but there is a body of useful experience about what

works that can help top management to improve services today and

build long-term capacity for the future.

I NHS Plan: A Plan for Investment, A Plan for Reform, Department of Health, 2000.

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EXPECTATIONS FOR PUBLIC SERVICES

The modernisation agenda calls for significant improvement in performance

throughout the public sector.

INTRODUCING ELECTRONIC PATIENT RECORDS

Background: Inadequate patient records are a major source of risk and

avoidable cost in hospitals. Patient care is jeopardised and professional time

wasted by inaccurate, illegible or lost paper records because the correct

information is not available at the time and point of decision making.

Impact: Introducing electronic patient records (EPR) would help to reduce risk

and cost, supporting other systems such as automated test results and

electronic prescribing. The technology to deliver EPR in hospitals has been

around for more than ten years, but only a handful of hospitals have

implemented these systems successfully. Meanwhile, research has shown that

11 per cent of patients experience an ‘adverse event’ while in hospital,

one-third of which lead to greater disability or death. Each adverse event leads

to an average of eight extra days in hospital, costing the NHS an additional

£1.1 billion a year in total.

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EXHIBIT 1

“[Best value] will make a vital difference to thequality and effectiveness of local services”Local Government Minister

“At every level there will be radical change”Prime Minister, NHS Plan

“Over the next few years patients will see majorimprovements in their local health services”Secretary of State for Health, NHS Plan

CASE STUDY 1

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Critical factors

Introducing EPR is a particularly complex challenge requiring a number of

significant barriers to be overcome. The reasons why successful implementation

has not been more widespread include:

• inability to sustain commitment to EPR in the face of other more urgent

priorities;

• failure to place the systems development within a local vision for

improving services to patients;

• no concerted communication effort to convince politicians and the public

of the value of spending money on support systems rather than front-line

care initiatives;

• insufficient emphasis on changing the behaviour of large numbers of staff

across the full range of clinical specialities; and

• failure to protect additional resources for the new systems.

The purpose of this paperAt all levels of the public sector, people are asking questions about

how to manage and lead change successfully. The sheer size and range

of the academic and management literature on change can be

daunting, particularly as few models have been rigorously evaluated.

The National Co-ordinating Centre for NHS Service Delivery and

Organisation R&D (NCCSDO) aims to help practitioners to find their way

through the literature with its recent series of publications.I This paper

is intended as a guide to change for top managers of local government

and NHS bodies who are responsible for delivering services to their

communities.

Clearly, chief executives in the NHS and local government work

within different organisational, legislative and political contexts, and

face different challenges in their approach to change. For local

government, the local political dimension is crucial. For leaders in the

I Organisational Change: A review for managers, professionals and researchers, Iles

and Sutherland, 2001. There is also a companion booklet, Different and Better?:

Learning from change in the health service, and reference card, Making Informed

Decisions on Change: Key points for managers and professionals.

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NHS, many of the most difficult issues lie in the relationships between

professional groups and an overload of priorities from the centre.

Increasingly, having an impact on the most intractable public service

issues means managing change across organisational boundaries and

in partnership with others. Nevertheless, there is a core set of

challenges in delivering successful change, whether it is in social

services, education, the NHS, police, fire or indeed across all large and

complex organisations, both public and private. It is these core

challenges that this paper addresses.

The material is based on the Audit Commission’s accumulated

understanding, through its experience of audit, research and

inspection, both alone and in partnership with others, of how local

bodies can manage change successfully and overcome barriers to

improving services. It is derived from practical experience of change

management in both public and private sectors. It also draws very

selectively from the academic literature and builds on a series of

interactive workshops where managers, change experts and

Audit Commission staff shared and explored their experiences of

making change happen in public services. It is illustrated with examples,

chosen to highlight some of the key lessons and show how they have

been applied in practice. It is intended as a reasonably quick and

interesting read for chief executives and their executive teams as they

steer their own local organisations through the change process. It may

lead local teams to reflect upon how they themselves are managing

change, and perhaps to take stock of their approach and identifying

some things to do differently. The package includes this paper and an

interactive web-based tool which presents the key concepts in an

accessible form and includes a library of case studies (available at

www.audit-commission.gov.uk/changehere).

Insofar as they describe the change process and highlight the key

issues for local leaders to consider, the paper and website are likely also

to be of interest to politicians, non-executives and policymakers, who

themselves need a sound understanding of change processes. Finally, it

will be relevant to organisation, strategy, human resource and

knowledge and information specialists and others in corporate roles

who are concerned with organisational change. The Commission is very

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interested to learn more about the experiences of public service

leaders who have been managing change. If you have any feedback on

this paper or would like to share your own organisation’s experience of

the change process, please contact the Commission’s Performance

Development Directorate by letter, telephone or email to

[email protected].

This introductory section concludes with a definition of four broad

types of change and highlights the transformational model as most

challenging and relevant for today’s public services. The following

chapter explores the role of leadership in delivering performance

improvement. The remaining material is organised into six sections on

key aspects of change management, each covering ideas that people

have found useful in achieving change and overcoming barriers to

service improvement.

Four types of changePart of the debate surrounding change management focuses on

the question, “what kind of change is this?” People commonly

distinguish step-change – often seen as linear and top-down – from

continuous improvement – generally depicted as an ongoing cycle, with

the momentum more likely to come from the grass roots of the

organisation. A simple, helpful way of categorising change is to think

about two dimensions: how radical: step-change or incremental; and

how centrally controlled: directive or organic. Combining the two

dimensions gives four broad types of change, as described by Ruddle

and Feeny,I whose relevance depends on the current performance of

the organisation and the predictability or otherwise of its environment

[EXHIBIT 2, overleaf]. Each type of change has its place. One organisation

may need to go through different types of change at different times

as its performance improves or deteriorates and external conditions

change. The important thing is that the process fits the purpose.

I Transforming the Organisation: New approaches to management, measurement

and leadership, Ruddle and Feeny, 1997.

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FOUR TYPES OF CHANGE

Transformation is the most relevant type of change for many public services

today.

Incremental-directive: operational gains• Successful organisations in stable environments can go for

operational gains where change is programmed in detail with a

controlled and monitored approach. Stability is a prerequisite for

this kind of change because it is centrally driven and does not rely

on bottom-up learning and live feedback about how things work in

practice, or how customer needs or external conditions are evolving.

Given the right conditions, it is less risky and lower cost than other

approaches. It can be useful for driving down costs and raising

productivity. However, it does not tend to work forever: there

comes a time when the external world moves on and an

organisation that relies exclusively on programmed operational

gains will find itself out of step with customers or, in the commercial

world, eclipsed by competitors.

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EXHIBIT 2

Directive Organic

Incremental

Step-change

Surgery Transformation

Operational gains Evolutionary learningScale of change

Style of change

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Step-directive: surgery• Where a radical shift is needed, objectives are clear and can be

tightly monitored and the environment is predictable with defined

goals for the organisation, a highly planned and prescriptive

approach can be successful. This might be described as ‘marching

out of a crisis’ or ‘strategic surgery’. It works best in relatively simple

organisations or in clearly identifiable business units within a larger

and more complex whole. The National Literacy Strategy is an

example of this approach. Turning around a failing direct labour

organisation would be another. It requires concentrated energy and

determination on the part of the leadership team to overcome

resistance, and often involves drastic steps, including the loss of

many jobs. The organisation that emerges at the end of such a

process may be very different from the one that went in, but the

hearts and minds of the individuals within it may not have moved

on to the same extent.

Step-organic: transformation• The most challenging conditions are a need for much better

performance in an environment of continuing uncertainty. Here

transformational change is called for, where visionary leadership

and a broad cross-section of management must own the process

and work together to identify and follow the path for the journey.

Change is initiated and led from the top, but detailed changes in

working practices emerge through a process that engages and

involves many people throughout the organisation. Transformation

may be kicked off on a broad front, touching on all parts of the

organisation at the same time. This is the riskiest approach, and few

organisations can cope successfully with the upheaval it creates. An

alternative and less risky route to transformation is to select one or

more targeted areas to work on first. The initial project/s should

ideally involve significant cross-functional change and pave the way

towards the overall vision, such as becoming a more customer-

focused organisation. The changes needed to deliver these major

projects can then unlock the potential for further dynamic shifts

through, for example, introducing new ways of working;

developing new capabilities; establishing more flexible personnel

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policies; developing people; delegating greater responsibility to

operational staff; upgrading the technology platform; and

providing essential learning about managing the process of change.

Several local authorities are currently engaged in this type of

change [CASE STUDY 2].

Incremental-organic: evolutionary learning• Where the organisation is clear about its strategic direction and is

performing well, but operates in an uncertain environment with a

lack of well-understood good practice to draw on, evolutionary

learning at all levels of the organisation enables progressive

experimentation, focusing on the user. This approach could work

for police basic command units as local crime patterns change, for

example, or for primary care trusts as they become established. It is

often appropriate for organisations that have come through

transformation: having achieved high performance levels, they then

need to keep innovating to remain at the leading edge. Such

evolutionary learning can succeed until a discontinuity in the

external environment, perhaps several years down the line, which

precipitates a fundamental strategy review that could in turn lead

to a further phase of transformation.

LEADING AN ORGANISATION OUT OF CRISIS

Background: Liverpool City Council is in the process of transforming itself

from one of the worst performing local authorities in the country into a well-

run organisation that is capable of delivering quality services to the people of

Liverpool.

Approach: An effective partnership between political and managerial leaders

is helping the city council reverse 30 years of organisational decline. The leader

and new chief executive began their campaign by setting out a vision of

Liverpool as a Premier European City. Raising aspirations and building

confidence helped to sustain the city council while it transformed a failing

organisation. An entirely new top executive team was recruited to overturn the

deeply rooted culture of departmentalism, antagonism, mistrust and outright

hostility between different departments and between senior officers and

members. Executive directors now have individual responsibility for priority

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areas that cut across traditional departmental boundaries. By spending

concentrated time together off-site, leading members and senior officers have

built trust and developed and published a set of values. The chief executive and

five executive directors operate on the principle that “if you talk to one of us,

you talk to all of us”.

To become an effective service provider, the council needed root-and-branch

reform: “When I first arrived it felt like 23,500 people against me” (chief

executive). Forceful central leadership challenged entrenched vested interests

and at the same time invested heavily in building and maintaining support for

the changes among council members and staff. For example, staff now find out

about important developments in letters from the chief executive sent to them

at home rather than from the local paper and the unions. Meanwhile, senior

managers have been empowered to make the required improvements happen:

“We’ve given our directors more delegated power than has ever been seen in

this city” (leader). By avoiding compulsory redundancies, headcount reductions

of almost 2,000 have been achieved without industrial action.

Real service improvement is a long process and has been tackled in stages.

Early on, external consultants underlined and amplified the messages in a

damning OFSTED report. The threat of losing control of education to

government-imposed management and privatisation forced unacceptable

service standards to improve, with help from the IDeA: “Education was entirely

command and control in the first six months, and then became deeply

empowering” (chief executive). In the press release on OFSTED’s re-inspection

report, the Schools Minister said, “From being a failing authority 18 months

ago, Liverpool are now delivering an effective education service…The progress

that has been made shows that even the most disadvantaged education

authorities can succeed with the right leadership.”

Liverpool Direct has been created as a phone-based one-stop-shop for council

services. With more than 125 staff, it is now Britain’s largest local government

call centre. It operates until 8.30pm and over weekends, with free red phones

in libraries and other council buildings. Costs have been reduced and

responsiveness improved by moving individual services into Liverpool Direct, in

one example removing ten people from the decision chain that is triggered by

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the report of an abandoned vehicle. While the current focus is telephone-

based, the council aims to integrate personal, telephone and electronic

contact, and has plans to offer interactive web-based access as well as rolling

out a programme of one-stop-shops throughout the city. To develop the

information and communications technology systems needed to support the

new council, IT staff are being transferred into a joint venture company

managed by BT.

Impact: The transformation of the council is still in its early stages. Progress is

fragile in some areas, and remains heavily dependent on a small group of key

individuals. The partnership with BT carries the normal risks of major systems

change and innovation. Not all front-line staff recognise the full scale of

change taking place, nor sign up to the new vision. There are pockets of

resistance where initial results – such as a rise from 20 per cent to 100 per cent

of looked after children with an allocated social worker – may mask the fact

that the old culture remains largely intact, along with traditional defensive

behaviours and “bias for inaction”. Dramatic organisational changes have not

yet all been translated into service gains on the ground: “The PIs are our

obsession. We actually track them monthly. We have reduced our staff, taken

£65 million out of our cost base and yet the PIs are improving. It is a

remarkable about-turn, but there’s still a long way to go” (chief executive).

Critical factors

• Visible, committed and effective leadership, with a strong partnership

between leading members and officers

• Delegation within a powerful overall vision

• Investment in communication

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The current gap between expectations and delivery implies that,

for many public service bodies, a step-change in performance is now

required. ‘Success’ means achieving tangible improvements for

customers through a change programme that leaves your organisation

not depleted, demoralised and exhausted but energised, with its

capabilities enhanced and the potential of its people freed up for the

future. The challenge, then, is for step-change in performance to deliver

improved results and a change-friendly organisation ready, willing and

able to move into an ongoing cycle of continuous improvement.

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KEY POINTS

Change management is one of the greatest challenges facing

local public service leadership

• Change is not a simple, linear process, and sustained

improvement is very difficult to achieve

• Incremental change is not sufficient to meet public and

political expectations

• Organisations can use a step-change programme to build

the capacity for continuous improvement

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2. Role of theleadershipteamLeading change

The four leadership roles

Key points

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Leading changeLeadership is central to the quest for real and durable change.

Public sector leadership is increasingly emerging as a topic of interest

(see, for example, the recent Performance and Innovation Unit (PIU)

research paperI which stresses that a clearer, shared understanding of

what leadership behaviours work in delivering today’s public services is

fundamental to improved leadership). Concerns centre on a leadership

deficit, due to a lack of leader development and the thanklessness (too

many demands, too few resources, too little real control) of so many

leadership roles, making it hard to attract and retain effective leaders

in the public service. The public sector is not always perceived as an

attractive career option. The PIU report suggests that this might be due

partly to features of the operational environment that can act as

barriers to good leadership, such as risk aversion, a blame culture, the

lack of opportunities for reward and recognition, and the often unclear

division of labour between politicians and officials. Perceptions about

pay, conditions of work, progression and the value placed on the work

may also contribute to the disincentives.

Change is one of the greatest demands on leadership, and evidence

from public sector performance and the attitudes of staff underline the

scale of the challenge [EXHIBIT 3, overleaf]. It was once the case that the

leader (chief executive, managing director) of an organisation was

expected to understand all the relevant technical areas encompassed by

the ‘business’ and was thus able personally to develop strategy and

make all key decisions. Those who reported to the leader exercised

delegated management of the operational detail within their own

functional areas. The days when that was an effective model are long

gone. Leadership is increasingly a team as well as an individual

challenge. Organisations are too complex and interdependent for one

individual, however talented, to make all the decisions, even within a

clear set of strategies defined by politicians. New structural forms, such

as partnerships, are assuming increasing importance.

I Strengthening Leadership in the Public Sector, Performance and Innovation

Unit, 2001.

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These involve leadership roles that extend beyond traditional

organisational boundaries. And taking the perspective of the patient or

user increasingly requires co-ordinated planning and decision making

across several bodies within a locality. This growing complexity and

interdependence affects the type of change that today’s leaders are

engaged in.

In local government, the distinction between political and

managerial leadership and the relationship between them has become

a major theme in its own right, particularly with the advent of new

political governance structures. The emergence of the cabinet model

has prompted a redefining of boundaries between political and

managerial leadership. In the NHS, the relationship between clinical

and managerial leaders, the establishment of clinical governance and

the role of non-executives are all important factors affecting the

management of change. Despite these different contexts, top managers

seeking to bring about change in large and complex organisations face

a common set of challenges. This paper aims to explore the challenges

shared by the executive teams of local authorities, NHS trusts and a

myriad of other big organisations.

The leadership of complex change demands a visible and

committed top team. Your team is likely to focus on the chief executive

and directors of a single organisation, or be made up of leaders from

more than one body working together to bring about cross-cutting

change. Either way, the principles of change leadership and

management remain very much the same. You need to be more than a

group of disparate individuals with specific functional roles, but rather

a genuine team with a shared sense of purpose and collective

responsibility for delivering the end goals [CASE STUDY 3, overleaf].

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ATTITUDES TO CHANGE AMONG LOCAL STAFF

While nearly three-quarters of staff understand the need for change, less than

one-quarter think it is well managed.

Source: MORI (Sharing A Vision, 2000) Question: To what extent do you agree or disagree

with the following statements?

SIGNALLING CHANGE ON ALL FRONTS

Background: The London Borough of Barking and Dagenham (LBB&D) is

changing from a paternalistic, traditional authority into a modern London

borough that is actively seeking to improve. External challenges have helped

to drive change, through the introduction of best value and a highly critical

review of LBB&D social services, which placed them under special monitoring.

The borough is now working to overcome a culture of poor cross-directorate

working by members and officers, and low levels of public involvement in

service development and implementation.

Approach: The 1997 local and general elections saw the council leader come

to the end of his term and the chief executive announce his retirement.

Up to this point, both political and organisational leadership had been

characterised by inertia, and LBB&D had found it very difficult to initiate

significant change. Convincing members, staff at all levels of the borough and

CASE STUDY 3

I understand the needfor change

I support the needfor change

I look forward to changeas a challenge

The reasons for change arewell communicated to me

Change here is wellmanaged

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10 6

13 6

35 7

39 10

Percentage agree Percentage neither/nor

Percentage disagree Percentage don’t know/no opinion

EXHIBIT 3

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the wider community of the need to change has been a theme of LBB&D’s

progress so far.

Members and officers were keen to adopt the modernisation agenda for public

services, and to respond to external challenges, but lacked a vision for a

modern LBB&D. In the leadership gap, senior officers managed themselves,

reshaping the top team and taking turns to chair. They focused on developing

new corporate priorities and engaging the support of members for

wide-ranging changes, beginning with modernising the way that the borough

is managed. Officers have worked to establish new relationships with

members, such as through a series of workshops to develop community

priorities using an external consultant, and Saturday briefings to keep them

abreast of best value developments.

Acting on the challenges provided by best value, LBB&D has made a good start

towards developing meaningful, community-wide consultation:

• The findings of a borough-wide community survey signalled the need for

change and were used by members and officers in workshops to help to

shape corporate aims and match them to the community’s experience.

• In 2000, Barking and Dagenham citizens’ panel was established by MORI

on behalf of the authority. The panel of 1,000 residents was selected to

represent a cross-section of the community. It was consulted on last year’s

performance plan and the borough’s draft community priorities, and has

provided comments on a range of services so far.

• Six community forums have been established, providing ongoing feedback

about the types of change they want from the borough. Officers and

councillors discuss detailed issues as residents raise them. The community

forums have now been given some decision-making powers on budgets,

so that they can select and fund projects in their local areas.

LBB&D’s new chief executive sees his role as promoting and sustaining the

impetus for change, developing and communicating a shared sense of

direction. Under his lead, LBB&D takes reputation management seriously and

actively seeks external awards and recognition to signal confidence in its

progress. Badging the change programme as ‘Barking and Dagenham 2000’

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has raised its profile and sent clear signals across the authority that LBB&D

was determined to improve. Monthly newsletters were issued to all personnel,

and the borough used the title for formal ‘Barking and Dagenham 2000’

briefing days for all staff, with professional audiovisual support and polished

presentations to communicate the change programme and reinforce the fact

that it is now doing things differently.

The borough expects staff to develop in line with the new ethos, and has

revised its staff performance management system accordingly. The chief

executive published his own objectives within the authority, showing his

accountability and demonstrating the links between personal and corporate

objectives. Competency assessment was established for the senior team and

the process is now cascading through the organisation, with some staff leaving

as a result. LBB&D is considering new ways to present itself as an attractive

and competitive employer. The borough is now developing a balanced

scorecard as a method of translating the corporate objectives into service

targets and actions to improve local service delivery.

Impact: An IDeA peer review in March 2000 recognised the progress that the

borough has made in modernising. A recent best value inspection of political

and community leadership has reported that LBB&D’s performance is fair and

will probably improve significantly in the short term. It found that corporate

aims were owned by the council’s political leadership and senior management

team. It also reported that LBB&D had made a positive start to improving

communications with the public. A recent survey showed that 70 per cent of

tenants believed the borough took their views into consideration when making

decisions. The borough was also shortlisted for two Local Government

Chronicle awards. Between 1997 and 2000, education in the borough was the

fastest improving in the country for Key Stage 2. In April 2001, special

monitoring was lifted from social services.

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The leadership team at LBB&D recognises that changing the culture of a whole

borough will take much more time, and that progress is still fragile. The

leadership team is also aware that work needs to be done to improve the

borough’s performance on equalities issues, and this is now at the heart of the

borough’s programme for change. Non-executive members must also

understand their role in the modernised borough and councillors should

actively challenge its performance and progress.

Critical factors

• Leadership team signalling the need for change at every opportunity

• Making use of external pressure and engaging members to create

momentum for change

As the leadership team in an environment that is constantly

generating new demands, change is part of your daily lives. Guiding the

organisation through a change programme, your collective aim is to

deliver tangible results and, in doing so, to create a change-friendly

organisation that is capable of continuous performance improvement.

To do this, you need, as a team, to have a common understanding of the

change process and of your leadership role within it.

The four leadership rolesWe have defined change leadership as a team responsibility.

Leadership teams are made up of individuals who have different

leadership styles. There is no single model of leadership style that is

needed to deliver change successfully. However, we have defined a core

set of leadership roles that are particularly important for steering

through change. They can be grouped into four areas, which together

constitute transformational leadership [EXHIBIT 4, overleaf]. The

emphasis on each area varies through the different phases of a major

change programme (see section ‘Sustaining focus on the key priorities’,

page 52).

17.

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FOUR KEY DIMENSIONS NEEDED TO LEAD CHANGE

The emphasis on each leadership role varies through the different stages of a

major change programme.

Source: Audit Commission adaptation of Accenture

The four change leadership roles are:

Inspire• Develop a shared vision that people inside the organisation and its

major external stakeholders can buy into and endorse. Achieving

this will clearly be highly dependent on the nature of the

organisation – in a local council it will happen in a very different

way than, for example, in a police force. The more that the vision

has been developed in an explicitly inclusive way, the easier it will

be to convince others to support it.

18.

Navigate Inspire

Enable Mobilise

Set directionand prioritise

Co-ordinateSet targets

and scorecards

Allocate adequateskills/resources

Invest in significantinfrastructure projects

Decide anddelegate

Develop visionProvide role modelsCoach, counsel,sponsor

Sell the vision totarget communitiesListen and respondProactively managestakeholders

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EXHIBIT 4

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• Act as role models for the organisation; for example, in the

emphasis that you place on listening to customers and in the way

you treat your staff. Top team behaviour sends powerful signals,

both positive and negative. Behaviour that runs counter to the

vision will be noticed and can seriously undermine the culture that

you are trying to establish. For example, firing a senior manager for

a single adverse event that reached the press while failing to react

to time and budget overruns on a major corporate project sends a

strong message about what your organisation regards as important.

Your attitude to managed risk-taking and the way you react when

things go wrong have a profound influence on behaviour at all

levels of your organisation.

• Finally, you will need to develop the next generation of leaders by

coaching, counselling and sponsoring talented individuals at all

levels of the organisation. Big change programmes tend to cut

across traditional hierarchies and provide valuable opportunities for

less senior staff to take on leadership roles as part of their

development.

Mobilise• Communicate the vision to staff and stakeholders to build support

for the change programme. It is important to have a clear picture of

the key interests whose support you need; this could include

councillors and non-executives, staff in your own organisation,

unions, partner bodies, users, the community you serve and specific

groups within it. You will need to identify the most important

groups and individuals in relation to your own change programme

to develop a robust communication strategy, and have a good grip

of the communication function to ensure that the messages are

delivered to the right audiences in the appropriate way.

• Reassure significant stakeholders that their voices are being heard

[CASE STUDY 4, overleaf]. It is valuable to have an understanding of

their concerns and to involve them as far as possible in the change,

at the very least providing ongoing feedback where a meaningful

dialogue is impossible.

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SYSTEMATICALLY BUILDING STAKEHOLDER COMMITMENT

Background: From 1998 onwards, NHS modernisation has required Bradford,

as elsewhere, to form stable and functioning primary care groups (PCGs) and,

in time, primary care trusts (PCTs), that meet the specific healthcare needs of

local people and improve local health.

Approach: In 1998, Bradford Health Authority (BHA) divided up the Bradford

area based around viable population sizes for new PCGs, and proposed a

configuration of four PCG/Ts that created all-new boundaries. The new

Bradford South and West PCG/T of around 150,000 people had no ‘natural’

geographical focus or sense of cohesion. It required the merger of three fund-

holding consortia with little shared history or established co-operative

working, and some local GPs were hostile to the change.

The PCG chair (and subsequent PCT chief executive) and board sought the

support of all clinicians, plus local community and voluntary workers, as the

commitment of all stakeholders was key to successful change.

The board recognised that it was not enough to overcome GP resistance, even

though this in itself was a challenge: all stakeholders had to accept the PCG/T

as the focus of future primary care services, and build a shared sense of identity

and a commitment to the new organisation.

This became the early priority of the PCG/T board. It devoted huge personal

attention and energy to building relationships with clinicians and the local

community. Board members listened closely to what was happening on the

ground, maintained a high profile around practices and made sure that they

were accessible to all GPs, intervening directly to deal with local problems or

rumblings of concern about the planned changes.

Given the disparate group of stakeholders, the PCG/T recognised the need for

consistent messages and clear, up-to-the-minute internal communications

within the PCG board and management team, and with all stakeholders.

Regular, purposeful meetings with GP-leads and allocated time for every

practice to discuss the changes helped clinicians feel that they owned and

were driving local strategy: “What really achieved results was the sense

of identity among all stakeholders that the PCT was theirs and they could

CASE STUDY 4

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shape its development” (PCT chief executive).

BHA acts as enabler for the change, monitoring progress with a light touch as

long as the PCT delivers excellent performance, but making it clear to PCT

managers that they should expect much closer attention should performance

slip.

Impact: By securing GP involvement, Bradford South and West PCT has made

significant developments in local services:

• GPs carry out a range of specialist procedures including minor operations,

diagnostics and triage of out-patient referrals. This ensures that patients

meet with consultants with all supporting test results ready and shortens

the time to treatment;

• specialist primary care services look after people with diabetes

and identify, then care for, people with early signs of coronary heart

disease; and

• practices promote well-being and tackle the causes of ill-health, for

example using lifestyle assessments and prescribing programmes of health

and fitness.

The GP specialist scheme has carried out 6,000 procedures and 9,000 out-

patient appointments, helping the PCT (and the HA) achieve their waiting

times and list targets. The PCT has received national recognition for its work so

far and is a beacon site for implementing GP specialisms. The Secretary of State

for Health has praised its approach to health promotion, saying: “What we are

seeing here in Bradford is practically what we would like to see across the

country...”

Critical factors

• Focusing energy on key stakeholders

• Establishing a high profile presence and intervening personally when

needed

• Building consensus by communicating clearly and honestly

• Understanding what motivates key stakeholders to harness their support

• Allocating time for stakeholder involvement in debate and discussion

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• Focus and prioritise to deliver a successful change programme.

This will inevitably mean reducing the emphasis on some areas that

are seen as important (see section ‘Sustaining focus on the key

priorities’, page 52). This re-prioritisation needs to be explained to,

and understood by, your key stakeholders. Local leaders are

required to find a balance between legitimate national priorities

and specific local needs. Best value provides a framework to support

this prioritisation through a council’s best value performance plan

and the programme of best value reviews. Implementing local

public service agreements will place further focus on priorities for

performance improvement in key areas agreed between local and

central government. In the climate of initiative overload in the

NHS, careful communication is needed to build understanding and

buy-in from regional offices for the priorities that you have set.

External stakeholders will want reassurance that your approach will

deliver tangible gains in a realistic time period and will lay the

groundwork for broader improvement after the first wave of

changes have come through.

Enable• Create space and find resources. This means making tough and well-

informed choices about where money can be found. Having control

over the finance function is critical to ensuring that resources and

policy run hand in hand, as they should. Picking individuals with the

right skills to lead the change process is also key. Deciding how to

resource the programme always involves tensions and dilemmas.

The problem is knowing how to balance the need to keep the show

on the road – continuing to deliver adequate services day-to-day –

while freeing up sufficient time and resources to invest in the

change programme. Inevitably, the staff you would most like to

have leading the change are the very people who are most difficult

to spare from their day jobs. Typically, such capable individuals hold

key roles and already carry an unreasonable workload. Releasing

able staff is only possible where departments are prepared to

shoulder the extra burden, and where a sense of excitement

encourages staff to risk investing their energy in something

uncertain. This is yet another reason why the active support of the

senior team is so essential.

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• Recognise and accept that change requires flexibility of people and

investment. Part of the leadership role is actively reprioritising and

negotiating to find the critical resources when they are needed. In

the modern environment, it is difficult to envisage any major

change that does not, at some stage, require investment in

infrastructure projects, particularly information technology. The

other support functions that are likely to be stretched are in the

human resources area, as changes affect the kinds of people you

need, the roles and skills that are required, the way that people

work and how they are assessed and rewarded. As changes affect

jobs and terms and conditions, a proactive approach to industrial

relations is essential.

• Make the key decisions quickly. It is deeply disempowering to work

in an organisation where there is no clear decision making or sense

of urgency or purpose for improvement. The organisation will be

able to deliver against the vision only if key decisions are made

speedily and project managers are given delegated authority to

move things forward.

Navigate• Set the course for change and translate the vision into a

manageable programme. This requires ruthless prioritisation so that

the organisation is able to focus scarce resources on the things that

are needed to deliver service improvements.

• Co-ordinate the change programme through the top team as a

whole or a sub-group that is more involved in the mechanics of the

programme. The purpose of co-ordination is to keep the whole

programme on track, monitor progress and manage the trade-offs

and dependencies between different component projects with

good information and a light touch.

• Set targets and monitor performance. Your over-arching vision is

not useful as a management tool until it is translated into concrete

targets. By setting the overall targets you determine the direction

of the programme as a whole. By monitoring performance you can

keep track of your progress. Targets may be a combination of

process, output and outcome measures, but extended timescales for

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implementation mean that intermediate indicators will be needed

if you are to be sure that you are moving forward as planned.

Navigation needs to be an ongoing activity – setting the course

once and defaulting to automatic pilot will not keep the vessel on

course through the uncharted waters of change. Checking the

readings and recalibrating measures and targets is necessary

throughout the journey to make sure that gains are sustained, that

measures remain relevant and that targets continue to be

appropriately stretching.

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KEY POINTS

Effective leadership is key to delivering change

• Leadership is increasingly a team as well as an individual

responsibility

• Leaders must understand the process of change in order to

guide their organisations through the change journey

• Leadership styles vary, but a core set of change leadership

roles can be defined

– develop and promote a shared vision

– mobilise staff and stakeholder support

– make key decisions and navigate through the change

journey

– support the organisation to deliver

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3. LocalownershipBuilding support for change

The role of good practice

Communication

Key points

36


Building support for changeDirective change is possible, and can deliver impressive results in

certain circumstances, as discussed in the introductory section and

illustrated in case study 9 (the National Literacy Strategy), page 54. But

for organic or transformational change, some degree of local ownership

is imperative. It is also an essential building block for organisations

seeking to develop a capacity for ongoing improvement [CASE STUDY 5].

RESHAPING SERVICES TO HELP OLDER PEOPLE TO LIVE INDEPENDENTLY

Background: Older people needing help and support would rather be in their

own homes than in hospital or residential care. The challenge for Dudley Social

Services staff was to turn a largely residential care-based service into one that

helped people to cope at home.

Approach: Meeting clients’ aspirations required profound changes to the way

that services were delivered and the role of social services staff. Senior

managers shared a vision of home-based care with operational staff, who

turned it into clear objectives. They were challenged and supported by an Audit

Commission report.I Using it as a benchmark for local progress, staff report

that “it helped us to ask the right questions” about where money was spent,

what skills were needed, and how they might work with other local partners

in providing care.

Creating a residential rehabilitation service was an important part of the

vision. It provides care for up to five weeks, building confidence and

re-establishing the skills that older people need to manage successfully around

the home, such as basic cooking and using equipment for personal care.

Careful assessment and care planning are used to set goals with clients based

on their specific needs and priorities. A team that believed in changing the

ways it worked with older people led a pilot scheme, building relationships

with stakeholders – GPs and other community services, hospitals, and private

residential care homes – who, working together, form the network of support

needed for viable home-based care.

I The Coming of Age: Improving Care Services for Elderly People,

Audit Commission, 1997.

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Senior managers invested their time as influential ‘champions’, promoting the

service locally and within the wider authority.

Impact: The new residential rehabilitation service has proved highly effective

in enabling people to stay in their own homes, where previously permanent

residential care might have been the only option. Clients are very satisfied.

Monitoring and evaluation were built in so that staff in social services can

learn from user feedback and the experiences of similar services elsewhere.

This will enable the service to continue to develop and improve.

Critical factors

• Clear senior management vision, communicated well to staff and the

community

• Opportunity for enthusiastic staff to shape and test changes in the local

context to build wider commitment

• Senior management support for operational staff implementing the

changes

• Ongoing monitoring and feedback from clients

Not every employee has to be deeply committed to the vision for

change to succeed. But the majority of stakeholders and staff must

accept the need for change and support the leadership’s direction of

travel. In a large organisation, only a fraction of people affected by a

change programme can be architects, but a much broader group can be

engaged and involved in other ways [CASE STUDY 6].

LOCAL OWNERSHIP DRIVING A SERIES OF IMPROVEMENTS

Background: Ophthalmology at the Oxford Radcliffe Hospitals NHS Trust is a

high volume service, treating around 5,000 in-patients annually and providing

44,000 out-patient appointments. Waiting lists for eye surgery had been rising

since October 1997, and by March 1998 there were 2,250 patients waiting for

surgery. Additional funding to target waiting lists was applied to rectify what

was initially seen as a simple problem.

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CASE STUDY 6


Approach: A multi-professional team, consisting of the lead consultant, senior

nurse, directorate manager and trust waiting list officer focused on reducing

the growing waiting lists for cataract operations.

They calculated that increased theatre capacity was needed and, as a

temporary measure, held additional twilight operating sessions to clear the

backlog. Introducing telephone pre-assessment of selected patients and a

waiting area inside theatres helped to reduce time between operations and

enabled more people to be treated. One year on, lists had fallen by 13 per cent.

However, removing the bottleneck in in-patient activity caused the workload

for out-patient services to grow dramatically, increasing activity overall by

about 20 per cent. The review group therefore extended the programme to

cover all components of the ophthalmology service. They systematically

analysed the patient journey, from receipt of a GP referral letter through to the

end of treatment. The group was struck by the interdependency of services,

how many different staff groups were involved in the patient pathway, and

how little patients’ needs featured in the process.

Their analysis challenged long-standing practices, and involved local staff in

generating solutions for improvement. Staff identified making better use of

doctors’ time at out-patient clinics as critical to removing the new bottlenecks.

Having quantified demand, other staff were able to support doctors better by

implementing some ‘quick fixes’, such as:

• booking appointments to match the medical staff available for each clinic;

• agreeing appointment times in advance with patients, to help reduce

non-attendances;

• enabling patients to wait closer to consulting rooms; and

• having notes to hand in waiting areas.

To manage the increased workload for the whole out-patient service, doctors

introduced Saturday morning clinics and took an active part in developing new

targets and in monitoring progress.

Impact: Sustaining efficiency gains has proved difficult, but overall in-patient

activity has increased by 3.4 per cent and the waiting list has fallen by

10 per cent (over 200 people).

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Staff involvement in improving services has rippled outwards and led to further

benefits for patients. For example, analysing the patient pathway revealed that

staff in other departments, such as accident and emergency, spent a lot of time

directing ophthalmology patients around the hospital. As a result, signposting

has been improved.

Change is spreading beyond the hospital setting and now involves primary

care and community ophthalmology. Ongoing analysis of workload and activity

is generating new ideas to improve the efficiency and quality of the patient

experience, such as direct referral from community to hospital.

In 1999, the service was awarded beacon status for its waiting list initiative.

Critical factors

• Key staff led the change process, using their expertise and knowledge to

identify solutions and build support for change

• Change was built on a systematic analysis of bottlenecks in the service,

using activity data and a review of the patient pathway through care

Building support for change is a huge challenge for the leadership

team. Commitment is particularly difficult to engender where powerful

interest groups use a professional code to resist the direction of change

and, at the opposite extreme, where the people affected have no

meaningful involvement in decision making and where key issues are

decided far from the front line. Command-and-control cultures may

hold superficial appeal when it comes to driving through change. But it

is often precisely where individuals feel disempowered and distant from

decision making that change is resisted most successfully. Conversely,

autonomy and delegated decision making can be powerful allies of

change. They enable the people closest to customers to respond to

changes in the environment and better meet the needs of individuals

and communities [CASE STUDY 7, overleaf].

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EMPOWERING LOCALITIES TO IMPROVE

Background: In 1996, an Audit Commission reportI used fieldwork across

England and Wales, questionnaires from local education authorities (LEAs) and

a survey of parents, to highlight the mismatch between pupil numbers and the

number of school places. This mismatch was wasting resources where places

were unfilled, and causing large classes and overcrowding where more

provision was needed.

Approach: The analysis showed how local improvement was being blocked by

a ‘policy gridlock’ of conflicting messages from central government. The report

suggested a clear way out of ‘gridlock’ and became a powerful lever for

change. Policymakers responded swiftly by making LEAs accountable for

supply and allocation and empowered them to plan for and manage school

places. Subsequent policy changes, first highlighted in the report, include:

• targeted monitoring of school rolls, with a focus on any school with less

than 75 per cent of places filled. A school may provide a sound case for

staying open, such as geographical factors or the likelihood of a failing

school improving. If it cannot, the LEA has the power to close it and

redistribute resources more efficiently;

• school organisation plans where each LEA, in partnership with school

governors and other key local stakeholders, sets out its forecast of how it

intends to deal with the supply and demand for school places over a five-

year period;

• asset management plans, which support more local decision making on

the allocation of funding for capital improvements; and

• a new code of practice on school admissions, which ensures that parents

receive better and more consistent information.

Impact: Since 1997, surplus school places have fallen by 64,000.

Critical factors

• Objective evidence of the need for change

• Empowering localities to plan and manage their own resources

I Trading Places: The Supply and Allocation of School Places, Audit Commission, 1996.

CASE STUDY 7

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The role of good practiceIn the transformational model, successful strategies for change

combine committed and visible leadership (“There is no alternative to

change”) with the maximum degree of engagement and involvement

by staff and users. This still applies when adopting good practice that

has been successful elsewhere. The Audit Commission has always

stressed the need to tailor solutions to local circumstances. There are

many sources of good practice – including networks, beacons,

conferences, publications and databases – some of which provide

opportunities for continuing contact with other organisations for

ongoing learning. Whatever the source of good practice, the learning

from our research is clear: you cannot expect simply to import someone

else’s good practice into your own organisation. It is necessary to

re-examine, if not reinvent, the wheel, building on what other people

have discovered. There are two main reasons:

• The wrong solution: modern organisations are complex organisms,

each made up of specific individuals and with their own particular

heritage, existing within a unique network of relationships with

customers, stakeholders and other bodies operating together in the

local environment. No externally generated blueprint is likely to be

sensitive enough to accommodate this unique set of conditions, so

the detailed template must be developed locally.

• The right solution, not fully adopted: if you want people to change

their behaviour in any other way than following a simple, easily

enforceable set of rules, they need to invest in the changes you are

asking them to make. They need to be convinced of the benefits

both conceptually (this is good for customers and for the

organisation) and personally (this is good for me/ my family/ my job

satisfaction/ my career/ the rewards available to me) [BOX A].

BOX A: ASSESSING GOOD PRACTICE

“Don’t reinvent the wheel” is a familiar message. The successes and failures of

others offer useful lessons, but what works in one situation won’t necessarily

work in another. Involving your staff in modifying any ideas and practices

taken from other organisations to suit your circumstances is key to building

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local ownership.

Operational staff are well placed to:

• provide a realistic assessment of your present situation; where you are

now and where you want to be, and the local context, including the

resources available;

• assess good practice ideas from other organisations by asking:

– What exactly are they doing?

– Does it really work? What is the evidence for their claims of success?

– Why does it work? What elements are critical to success both in terms

of the circumstances and in the mechanisms used?; and

• assess how it might best be applied to your situation:

– What differences in the local context either require changes in the

mechanisms used or affect the prospects of success?

– How might the mechanisms be adapted to suit the local context?

– Would it then still be cost-effective, and what needs to be tested to

establish this?

They may want to pilot or experiment with ideas before introducing them

across the organisation. Your role is to make the high-level decisions and

provide the support and resources that operational staff need to develop, test

and implement the chosen approach.

Source: Audit Commission

To adopt solutions that will work, stakeholders must believe in

them enough to make them real. The key to this is for them, or people

whom they feel represent them such as unions, peers or user groups, to

have had a say in how things should change. Both organisations and

individuals can evolve sophisticated strategies for resisting and

subverting change, even while superficially appearing to accept it. This

is not to say that resistance to change can never be overcome, but

self-generated change has a much better chance of taking root and

delivering sustained improvements in performance [EXHIBIT 5].

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TYPICAL RESPONSES TO CHANGE

Involving stakeholders in a change programme increases the chance of

sustained improvement.

Source: Audit Commission

CommunicationDesigning meaningful stakeholder involvement into your change

programme is not a trivial task. Differential levels of engagement are

appropriate for different groups. There will typically be a core of highly

involved members (for local government), senior managers, clinicians

(in the NHS) and other staff who are central to shaping and driving the

programme forward. This core group will probably grow as the change

programme progresses and more people are drawn into it. Beyond the

core group, it is useful to develop a fairly comprehensive plan for

timely, purposeful, two-way communication with key stakeholders

throughout the stages of the programme, using a variety of different

formats, channels and methods.

This is best done in a systematic way, breaking down the priority

audiences into groupings by type (including staff, unions, customers,

community, other external stakeholders), role and level within your

own staff (recognising the legitimately differing communication needs

25.

24.

Outrighthostility

Refusal

Resignation

Industrial action

Tokencompliance

Lip-service tonew ideas

Subversion

Grudgingacceptance

Comply onlywhere

immediatebenefit evident

Lukewarmenthusiasm

Momentumstalled byobstacles

Realcommitment

Enthusiastic/evangelical

Willing totake risks

Persistent inthe face of

barriers

IMP

OS

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N

INV

OL

VE

ME

NT

Depth and durability of change achieved

Low High

EXHIBIT 5

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of managers, front-line and support staff, for example) and

geographical location. Against each group, the communication

objectives and activities can be mapped out over time to ensure an

ongoing flow of information and contact that enables you to reach out

to and influence key audiences and keeps them informed and involved

[CASE STUDY 8].

TARGETING KEY AUDIENCES TO BUILD SUPPORT FOR CHANGE

Background: In October 1996, The Ridings in Halifax achieved national

notoriety as discipline broke down completely during an OFSTED inspection. It

was labelled a failing school with miserable academic results and endemic

truancy and discipline problems, and placed in special measures with an acting

headteacher and associate head seconded in from other local schools.

Approach: The Ridings turnaround strategy was based on establishing a clear

vision for the school – to give pupils the best opportunity to fulfil their

potential by maximising the quality of teaching and learning – and engaging

the support of four key groups to deliver it.

• Headteacher and staff together revisited the school’s existing aims and

objectives to build a shared set of values and aspirations that guided every

individual change, from the timetable to praise letters, from lunchtime to

uniform and from the length of the school day to rewards for good

behaviour. For the first six months, quality of teaching was agreed as the

key priority and a tough but transparent performance management system

introduced to back it up. At a critical, high risk staff meeting, formal

classroom observation was accepted, along with re-establishing

management structures, and clarifying the roles and responsibilities of

every individual member of staff.

• The governing body at The Ridings had been severely criticised by

OFSTED, but through the appointment of some new members and with

active encouragement from the headteacher and her team, governors

were involved and engaged with the changes taking place at the school.

• The support and commitment of pupils was harnessed by responding to

their concerns, providing the stability and reassurance they were seeking

and moving from a negative, blame culture to one of positive

CASE STUDY 8

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reinforcement, where opportunities for praise were actively sought out.

The approach to dealing with low attendance was based around changing

what was on offer in the school, particularly for children with special

educational needs, to attract truants back into the classroom.

• Having expressed their anger and frustration at past failure, parents were

involved as part of the solution. A regular newsletter was established and

parents were invited to the praise assemblies that recognised pupils’

progress and achievements. Changes in response to parents’ views clearly

demonstrated that their voices were being heard. These included making

parents’ evenings much more welcoming and holding meetings of the

re-established PTA in the pub, where many parents felt more comfortable

than in school.

Impact: The Ridings is now judged by OFSTED to be a good and improving

school, where constant attention to the quality of teaching is reaping its

rewards, as evidenced by progress against many key performance measures.

Critical factors

• Shared vision

• Managed approach to engaging key stakeholders

MORI research in the public sector shows that staff who feel they

are kept well informed are twice as likely to:

• feel involved with their organisation; and

• understand its objectives.

They are also over twice as likely to:

• recognise clear goals;

• feel secure in their job; and

• feel that they can make the best use of their skills and abilities.

Good communication is one of the most powerful mechanisms to help

leadership teams to build understanding and support to deliver change

successfully. These days, communications thinking is well advanced and

an enormous variety of options are readily available.

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Techniques for community consultation are described in an Audit

Commission management paper.I

It is hard to overstate the amount of senior time and energy that it

takes to communicate a major change programme. Listening to leaders

who have transformed their organisations, this is frequently cited as a

key learning point because, when it comes to communicating about

change, many commonsense assumptions turn out to be wrong

[EXHIBIT 6]. Communication begins with convincing people of the need

to change. Your leadership team needs a powerful rationale for change

that chimes with the organisation’s own value system – its view of why

it exists and what it needs to do. The rationale needs to be persuasively

articulated and repeatedly reinforced in a simple way, using language

and symbols that people understand and identify with. Investment in

communication is needed throughout the change journey.

COMMON COMMUNICATION MYTHS

Many commonsense assumptions about communicating change are mistaken.

Source: Audit Commission adaptation of Jeanie Daniel Duck

I Listen Up: Effective Community Consultation, Audit Commission, 1999.

27.

EXHIBIT 6

We haven’t said anything yet so we aren’t communicating

We only need to communicate with the people who are directly involved

There’s nothing new to say so we don’t need to communicate now

It’s complicated and could be alarming if it’s misinterpreted,so we’d better say nothing

We’ve covered this before so we don’t need to say it again

It’s taken us months to work this out, but you’ll understand itafter one presentation/leaflet/conversation

Our job is to make the information available; anyone who’sinterested will come and find it

We must wait until we have all the answers before we communicate

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For communication to be effective, the channels must meet the

needs of the audience. Research shows that staff have strong views

about what kinds of communication they prefer and trust. It is hardly

surprising that they deeply dislike hearing news about their work that

directly affects them through the local media or the rumour mill. Team

briefings and face-to-face contact with line managers are the two most

favoured approaches. This highlights the need for an effective cascade

briefing system so that important messages about the change

programme can be quickly and accurately disseminated throughout the

organisation in the way that people prefer. Different sorts of

mechanisms are needed to pick up staff views and feed them into the

change programme [EXHIBITS 7 AND 8, overleaf].

HOW STAFF RECEIVE INFORMATION AND THEIR PREFERENCES

Staff prefer face-to-face communication with colleagues.

Source: MORI (Sharing A Vision, 2000) Question: Here is a list of ways of getting

information. How do you receive information and how would you prefer to receive

information?

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EXHIBIT 7

00 10 20 30 40 50 60 70 80 9

10

20

30

40

50

60

70

80

Percentage of respondents who received this type of information

Percentage of respondents who preferred this type of information

Video

Internet/email

Unions

NoticeboardsPress/external media

Grapevine/rumour Memos

Intranet

Senior management

Newsletters

Internal newsletter

Immediate manager/supervisor

Team briefings

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HOW MUCH STAFF TRUST DIFFERENT SOURCES OF INFORMATION

Team meetings are the most trusted form of communication.

Source: MORI (Sharing A Vision, 2000) Question: To what extent do you trust the

following sources of information? -2=not at all, +2=total trust.

Base: All working who expressed a view (net score).

Large-scale change is rarely possible without casualties. Whatever

mechanisms are used, the leadership team is ultimately responsible for

seeing that the negative effects on individuals are handled in a fair and

professional way, respecting the rights and dignity of those who must

go and managing the impact on those who stay. Maintaining

motivation and performance under these circumstances is extremely

taxing, and line managers who are directly affected are likely to need

extra support leading up to, during and after any restructuring

takes place.

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EXHIBIT 8

Team meetings

Managers

Internet

Companypublications

Trade union

Video

-10 0 10 20 30 40 50 60

Seniormanagement

Source of information

Net score of trust in information

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KEY POINTS

Building support for change is essential for continuous

improvement in a changing world

• Imposed change tends to be resisted over the long term

• Each organisation is complex and unique, so good practice

is best handled with care

• Communication is a critical activity to build buy-in

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4. Sustainingfocus on thekey prioritiesDoing less to achieve more

The change curve

Key points

52


Doing less to achieve moreThe necessity of sticking to a small number of key priorities in order

to achieve deep and durable change is illustrated well by the National

Literacy Strategy [CASE STUDY 9].

SUSTAINED FOCUS ON A CLEAR OBJECTIVE

Background: National tests of pupils during the 1990s showed that

attainment in literacy throughout England was unacceptably low. Fewer than

50 per cent of pupils at age 11 met national expectations in writing. Standards

of adult literacy continued to cause concern, and national and international

studies indicated that one in five adults had poor literacy skills, placing

England near the bottom of the European league table. Variable pupil

performance across local education authorities (LEAs), sometimes confounding

expectations based on socio-economic factors, encouraged the view that with

consistently high quality input there could be a levelling up of performance.

Approach: The DfEE employed a national team of key practitioners in literacy

education to devise a strategy that:

• identified the most effective teaching practices nationally and

internationally;

• provided a detailed blueprint for the skills and knowledge that should be

taught to all pupils from five to eleven years;

• disseminated key teaching practices to teachers through a centrally driven

professional development programme, managed through LEAs; and

• set clear expectations for daily teaching practices.

In September 1998, the strategy was introduced to all primary and special

schools, with comprehensive training modules reflecting key teaching

practices. Professional development programmes were produced centrally and

rolled out by literacy consultants, funded by the DfEE and LEAs, to teachers in

the lowest attaining 40 per cent of schools. All schools received central funding

for resources to implement the recommended practices.

Impact: Despite early resistance from teachers, headteachers and academics,

almost every school in England has adopted the strategy. Qualitative evidence

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CASE STUDY 9


suggests that pupils and teachers have increased motivation and subject

knowledge. In the last two years, standards nationally have risen by

10 per cent for 11 year olds and it seems likely that the programme will meet

its target set for 2002. All but a small percentage of LEAs have shown

significant improvements in pupil performance, particularly in reading. The

rigorous programme of professional development has given teachers a shared

language to discuss approaches to teaching literacy.

Central funding continues, but the focus has moved to increased local

ownership. Teachers will be encouraged to build on the national programme to

enable the strategy to evolve and deliver further improvements in literacy

standards.

Critical factors

The National Literacy Strategy shows how a highly directive approach can be

successful where there is:

• a recognised need for step-change, starting from a low performance base;

• good understanding of what works, supported by strong research

evidence;

• sustained focus on clear, quantifiable goals backed up by substantial

investment;

• close monitoring; and

• focus on a single sector, with limited interdependencies.

It is widely understood that organisations that attempt

simultaneously to pursue a number of unconnected strategies are

unlikely to succeed with any one of them. But in the real world of

multiple objectives and competing public sector priorities, defining and

sticking to a limited set of core goals is a major challenge

[CASE STUDY 10, overleaf]. Relentless focus on essentials is easier when

organisational survival is at stake, less so when there are many areas

that need improving but the overall situation is not in itself perilous.

Without a clear sense of strategic direction, the odds are stacked

against any major change programme.

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In local government, the strategic vision should emerge as a result

of the local democratic process, for which there is no direct local

equivalent in the NHS, police or fire services. New political structures

and the introduction of the cabinet system will also have an impact. But

in any local body, the executive team has a key role in translating

overall vision into a manageable programme whose constituent

projects can be delegated to teams within the organisation, and overall

progress and outcomes planned, monitored and measured. This

programme must, first and foremost, be owned by the top team, so that

when facing difficult decisions about where scarce resources and

management attention should be invested, there is consensus about

protecting what is necessary to deliver the change programme.

The need for the change programme to have the support of key

stakeholders, both internal and external has been described in earlier

sections. This support provides a vital buffer against the latest urgent

pressure or political enthusiasm, whether generated centrally or locally.

Proactively selling your vision is a necessary investment to create the

space for you as the local leadership team to pursue your goals in the

face of diversion and distraction. This probably involves explicit

handling strategies for the most influential people and groups.

A well-articulated vision, even a broad-brush one, that stakeholders

support, and which is seen to be delivering results in improved services,

is the most effective defence against the danger of new priorities being

imposed from outside.

FOCUSING ON CORE PRIORITIES

Background: In 1998, Birmingham City Council Education Welfare Service

(EWS) was criticised by OFSTED as being too broad-based rather than

concentrating on the areas that mattered most; improving attendance and

reducing school exclusions. These messages were echoed by the EWS’s own

consultation with headteachers.

Approach: The external auditor helped the service to develop an action plan

to sharpen its focus on core business and maximise EWS’s time spent working

in partnership with schools. The plan included:

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CASE STUDY 10

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• clearly defining how the service works with schools, including criteria for

involvement in individual cases and setting standards;

• reducing the range of functions covered by the service, limiting

involvement in issues other than attendance (such as supporting parents

of excluded pupils); and

• using qualified staff more selectively. Administrative staff took over tasks

such as hardship applications and finding school places, freeing up

education social workers’ time for attendance issues.

The management and structure of the service were revised to support these

changes, with increased accountability for all staff and improved reporting

mechanisms. A communications programme was set up to explain the

rationale for change and build staff support.

Outcomes are now closely tracked so that the service can identify needs and

problem areas more efficiently and allocate appropriate resources. Individual

school plans are used to monitor effectiveness against agreed standards and

provide regular feedback and direct support to schools. The service has also

developed a good practice guide on improving and maintaining pupil

attendance, which has been well received by schools.

Impact: A follow-up review by the auditor in 2000 showed that while absence

rates are still above the national average, they have improved, and faster than

the national rate, without any increase in cost. The proportion of resources

directed towards key areas has increased and education social workers now

devote an additional 10 per cent of their time direct to schools. The annual

survey of schools shows increased satisfaction with the service.

The next challenge is to build on this progress and strengthen the performance

management framework. This will be informed by the service’s best value

review, active collaboration with comparator LEAs, and an action plan

developed from the auditor’s review.

Critical factors

• Clear picture of core priorities, communicated well to staff

• Sustained focus and close tracking of what matters to users

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The change curvePersistence, resilience and consistency of purpose are essential for

delivering a significant change programme. The ‘change curve’

developed by Jeanie Duck,I neatly illustrates why this is so. The change

curve describes five stages that organisations typically go through in a

successful major change journey. It is possible to subjectively plot the

organisation’s morale and confidence as it progresses through the five

stages, producing a characteristic irregular curve [EXHIBIT 9].

THE CHANGE CURVE

Morale and confidence are likely to rise and fall through the five stages of the

change curve.

Source: Audit Commission adaptation of Jeanie Daniel Duck

I The Change Monster: The human forces that fuel or foil corporate transformation

and change, Jeanie Daniel Duck, 2001.

34.

Stagnation Preparation Implementation Determination Fruition

Time

Org

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and

conf

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EXHIBIT 9

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Stage 1: StagnationOverall performance is static or declining either in absolute terms,

or relative to the market or to stakeholder expectations. Often a large

number of low-level, unrelated performance improvement initiatives

remain ‘live’, neither linked to each other nor to any central strategic

vision, many having stalled or withered away without formal end points

or tangible results. A large police authority, for example, recently

commissioned external consultants to map all planned and current

reviews of its police force. The consultants found several hundred, but

no definitive list, nor any systematic way of managing or co-ordinating

them. There was also a lack of clarity about what the reviews were

trying to achieve and how recommendations would be implemented.

At this stage it is quite common to find more improvement on paper

than in reality – typically a proliferation of written strategies and plans

with unrealistic milestones and little in the way of follow-up or

accountability.

Stage 2: PreparationAt this stage, recognition typically dawns that overall performance

is inadequate and continuing on the current trajectory is unacceptable.

This may be the result of some kind of external scrutiny, possibly

accompanied by the threat of punitive sanctions, including direct

intervention and loss of control. It may come from listening to

customers, providing an unexpected and unpleasant picture of your

services from their perspective. This realisation, however it dawns, is

normally accompanied by a sharp dip in morale. The next step is

acceptance that change is needed, on a scale that implies significant

upheaval rather than marginal improvement. It may be clear that this

will be impossible to achieve with the current team, precipitating

necessary but potentially destabilising changes at the top of the

organisation. Once this phase is over, the senior team can focus on the

central vision, setting targets for future performance and a plan for

change, and establishing the central mechanisms and accountabilities

to move things forward. This may mean dedicated project teams with

some form of light touch co-ordination. As the teams kick off, creative

potential is unleashed to generate bold ideas, which are approved by

the leadership team for implementation. This creates a high level of

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energy and increasing sense that this change programme is going to

make a difference, where many others have failed. At this point, morale

can reach an artificially high point and unrealistic expectations can start

to build.

Stage 3: ImplementationThe rubber hits the road. Translating ideas into action is (always)

tougher than expected. This is the point at which jobs may be lost. Some

early wins may restore optimism about the programme as a whole. In

other areas, teething difficulties suggest that original plans may need

to be modified. The hard work of rebuilding supporting infrastructure

and systems – information technology, human resources, people

development, performance management – begins, and, at this stage,

demands maximum effort for minimal immediate gain. The honeymoon

period, if there was one, is over.

Stage 4: DeterminationMixed results from the first few months of implementation create

an opening for serious doubts to creep in. The programme runs into

significant organisational resistance and support begins to melt away.

Other more ‘urgent’ priorities threaten to distract management

attention and divert resources away from the change programme.

External commentators and/or the local press may pick up and amplify

individual instances where things have gone wrong, contributing to an

undermining of confidence. Internally and externally, advocates of the

programme and those most closely associated with it begin to feel

nervous. Detractors sense an opening and prepare themselves for the

counter-offensive. This is a critical point. Only determination and

renewed, visible commitment from the top team will see the

programme through this test.

Stage 5: FruitionGradually, even against the odds, the programme appears to be

delivering. Operational changes are translated into real results that are

noticed by customers, commentators and stakeholders. Perceptions of

the organisation are changing, both externally and internally. The

increased flexibility and power of new infrastructure begin to pay

dividends on a broader front. Managers have internalised the overall

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vision and make use of delegated powers to experiment with new

ideas. Limitations in the original blueprint for change are met by

renewed creativity and better solutions. The capability and confidence

built through the first wave of changes are embedded in the

organisation, as key figures in the change programme return full time

to their operational jobs or to new ones. Step-change has turned into

continuous improvement.

KEY POINTS

Real change requires sustaining focus on the key priorities

• More change is achieved through doing fewer things well

• Organisations with a clear direction and some

demonstrable results are better able to resist being

deflected and distracted

• Persistence, resilience and consistency are critical to stay on

track through the typical ups and downs of change

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5. Focus onusersUnderstanding users

Involving users

Measuring what matters tousers

Key points

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Understanding usersA change programme to improve public services that does not

begin and end with customers is unlikely to deliver its full potential, if

indeed it delivers anything much at all. User focus does not, of course,

imply that all customer demands can be satisfied. It is the role of the

political process, whether local or national, to reconcile expectations of

public services with the resources available to deliver them. This is, at

best, an imperfect system, leaving the local leadership team deeply

embroiled in managing the tension between potentially infinite and

contradictory demands and finite resources. There will always be

choices to be made. But the fact that the expressed needs of users are

not themselves rational and mutually consistent is not a reason for

avoiding objective investigation and analysis. Without knowing

anything about the people who use your service, how can you begin to

understand their needs? Without hearing what they want from you,

how can you focus on the areas that really matter to them? Without an

accurate picture of their experience, how can you be sure that you fully

understand what works and what needs fixing, especially where your

contribution is part of an extended process involving other agencies as

well as your own [CASE STUDY 11]?

JOINING UP SERVICES FOR USERS

Background: The London Borough of Hammersmith and Fulham’s housing

department is developing and joining up its services to meet evolving client

needs. In 1997, there was evidence of rising demand for support for tenants

with mental health problems and dissatisfaction with existing service

provision. Consultation showed that tenants were unhappy with mainstream

services and wanted access to specialist support. At the same time, housing

officers were worried by high rates of tenancy breakdown, with persistent

problems of rent arrears and neighbour complaints. There was also concern

from health and social services over the housing being offered to mental

health clients leaving hospital.

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Approach: A new Mental Health and HIV Housing Team was set up in 1998,

bringing together staff from different functions to respond more flexibly to a

wider range of client needs. A survey of mental health accommodation projects

helped to establish a profile of clients and their needs. A hospital liaison officer

was appointed to work closely with Charing Cross Hospital to meet the

housing needs of in-patients and to prevent delays to hospital discharge.

Performance indicators are now routinely used to track improvements and fine

tune the service.

Impact: Over a three-year period, the number of new clients helped has more

than doubled. The weekly total of benefits being paid following team

intervention rose from £952 to £3,987 between 1998/99 and 1999/00, and

rent arrears have reduced. Over the same period, hospital referrals provided

with accommodation rose from 26 per cent to 46 per cent and the proportion

helped to return to their own homes increased from 13 per cent to 27 per cent.

Client surveys show high levels of satisfaction, and feedback from housing

officers shows that they are much happier with the support they get in

providing a service to tenants with mental health problems.

A more detailed review of supported mental health accommodation is now

underway, as a result of a joint funding bid by the housing services

department, social services department and Ealing, Hammersmith and

Hounslow Health Authority.

Critical factors

• Keeping in touch with the changing needs of users

• Building partnerships with other agencies

Organisations develop their own internal belief systems that

become invisibly embedded in everyday decisions and behaviour. These

commonly include assumptions about who the customers are, what

they think about the organisation, how and why they use services, and

what they want and value [CASE STUDY 12, overleaf].

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RESPONDING TO USER FEEDBACK

Background: In 1997, the Oxford Radcliffe Hospitals NHS Trust was among

the poorest performing trusts in the Anglia and Oxford region, both for waiting

times for surgery and the number of people on surgical waiting lists. Only

40 per cent of cataract surgery was performed as day cases, compared to the

median for England of between 60 per cent and 70 per cent.

Approach: A team of ophthalmology staff (as described in case study 6) was

given responsibility to reduce waiting times and lists. Their role was to analyse

workload and demand, and identify solutions to make the service more

efficient. Increasing the proportion of people treated as day surgery cases had

the potential to alleviate pressure on in-patient wards and improve

throughput.

The team issued questionnaires to ophthalmology service users. Results

showed that patients were not choosing day case treatment because they had

to return to hospital the following day. The questionnaire also revealed that

patients living alone were particularly reluctant to undergo day surgery.

In response to user feedback, the ophthalmology department changed its

practice so that people undergoing routine cataract surgery were no longer

required to return to hospital the day after surgery. Telephone assessment

clinics have been introduced before admission, and rather than excluding

people living alone from the day surgery option, better information is given to

all suitable patients about the day procedure, and how they can expect to feel

and manage immediately afterward.

Monitoring user opinions has continued, overturning concerns from staff about

elderly patients travelling home after dark after the newly introduced twilight

operating sessions. Patients and their families reported that evening sessions

were more convenient as family members were often able to escort patients to

and from hospital when sessions fell outside normal working hours. In addition,

patients treated outside peak periods valued the less frenetic environment.

Impact: Uptake of day case treatment has increased: 80 per cent of people

having cataract treatment now return home the same day, instead of staying

overnight in hospital.

CASE STUDY 12

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Critical factors

• Staff cannot always predict users’ preferences or responses to changes:

direct user feedback tells staff what matters to them and why

• User involvement in change programmes can help to identify opportunities

to improve service efficiency

• Ongoing feedback helps to ensure that efficiency initiatives are compatible

with improving the quality of patient care

Without actively listening to customers and feeding that

information back regularly and quickly to inform staff and

management thinking, services can become dangerously out of touch.

Listening to front-line staff within your own organisation, such as

drivers, receptionists and others who have daily contact with customers,

is often a good place to start.

Many private sector companies are building up increasingly

sophisticated pictures of their customer base:

• distinguishing different types of customer with different profiles

and needs (market segmentation);

• collecting live feedback;

• undertaking indepth research about customer behaviour and

preferences; and

• using technology to track and analyse shopping habits.

Public services have other options available, including community

consultation (a variety of approaches is described in an Audit

Commission management paper,I which includes a pull-out wallchart

setting out the pros and cons of different methods such as surveys,

focus groups and panels). Many of the alternatives on offer are now

well established and expertise is widely available. However, few public

bodies fully exploit the potential that exists to develop a rich

understanding of customer preferences and apply it in their service

improvement initiatives [CASE STUDY 13, overleaf].

I Listen Up: Effective Community Consultation, Audit Commission, 1999.

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RESHAPING SERVICES IN RESPONSE TO USER FEEDBACK

Background: Following the 1993 Department of Health paper, Changing

Childbirth, the Audit Commission undertook national researchI and audited the

maternity services provided by individual NHS trusts throughout England and

Wales. Each audit included a survey of the views of a random sample of new

mothers to provide a user view of the services offered by the trust. The audit

of Trafford Healthcare NHS Trust identified a number of areas needing

improvement, including:

• unnecessarily long waits at antenatal appointments because some

consultants were doing routine check-ups for ‘low-risk’ women;

• a lack of continuity of care, with support during delivery coming from a

number of different people, rather than the same staff throughout,

because rostering did not allow for continuous care; and

• poor continuity and consistency of care on postnatal wards because staff

were being called away to assist busy labour wards.

Approach: A new clinical director and service manager of midwifery used

external evidence from national guidance, reports and the user survey as levers

to change clinical practice and move to a more mother-centred service. Key

changes included:

• involving midwives in restructuring their service. Midwife teams now see

women from designated local patches, so mothers can be supported by

‘their’ team both in the community and in hospital. Ward staff levels were

increased and shift patterns changed so that the same staff can attend a

woman through delivery and postnatally;

• developing a new protocol for ‘low-risk’ mothers, minimising antenatal

appointments with consultants and seeing women in the community; and

• introducing regular medical audit. Peers are now able to highlight and

challenge variations in their colleagues’ practice.

I First Class Delivery: Improving Delivery Services in England and Wales,


CASE STUDY 13

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Impact: Activity data from the hospital and staff feedback show improvements

across maternity services. Waits at antenatal clinics have reduced as many

women attend clinic only twice. Many clinics are now held at local general

practices. Women experience better continuity of care during and following

delivery from less pressured staff.

Critical factors

• Asking mothers what they think of the service

• Challenging established practice with a range of external and internal

information

Involving usersLeicester Royal Infirmary actively involved a panel of patients in the

early stages of its re-engineering project. Volunteers tracked the

pathway that patients followed through the hospital to complete

routine diagnostic tests. This revealed that the total distance travelled

by a typical patient between departments could be measured in miles.

The patient panel described their ideal of a one-stop diagnostic

appointment, where all necessary tests could be carried out in one

session, by a single person. Their idea was turned into reality in the

Balmoral Testing Centre, which is more efficient as well as more

patient-friendly.

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Measuring what matters to usersThoroughly understanding customer experience provides the basis

for setting targets and measuring the things that customers think are

important, as well as the technical efficiency and effectiveness

indicators that are the basis of a sound service. Moving through a

change programme, it is important to keep checking that your vision

and what you are delivering make sense to users and chime with what

they consider to be important. That may be, for example, improved

educational attainment and participation in the labour market or,

alternatively, clean pavements, playground swings and street lights that

work. In the case of accident and emergency services, the public may be

just as concerned about how far it is to the nearest A&E department,

how long they have to wait when they get there and whether the

environment is clean and safe, as they are with survival and disability

rates.

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KEY POINTS

To deliver their full potential, change programmes need to

begin and end with customers

• Service providers must understand what matters to their

customers (users, patients, carers and the community), and

how they experience the service

• Listening and objective evidence are essential to this

understanding

• Performance targets should include the things that matter

most to customers

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6. Managingthe changeprogrammeProject management

The balanced scorecard

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Project managementProject management is important in any major change programme.

Conceptually, this is probably the most straightforward phase: the local

vision has been developed, the analysis completed, the big decisions

made. All that remains is to put the agreed strategy into action. But

significant change is inevitably complex, with multiple, cross-functional

interdependencies and a confounding element of unpredictability. As

with understanding user needs, adopting a systematic approach to

implementation cannot in itself make messy, unpredictable reality

magically simple and manageable. Major change is not a

straightforward linear process, but managing the complexity is virtually

impossible without a robust plan that is supported by strong project

management [CASE STUDY 14].

RECOGNISING PROJECT MANAGEMENT AS KEY TO IMPLEMENTATION

Background: The Kings Mill Centre for Healthcare ServicesI had a serious and

ongoing problem providing sufficient ward nurses. To ensure safe levels of

staffing and avoid closing beds, the Trust became increasingly dependent on

commercial agencies for temporary nursing staff. Even then, agencies could not

provide enough staff to fill shifts, with the result that beds still had to be closed

and operations cancelled.

Furthermore, reliance on agency nursing staff potentially exposed patients to

increased clinical risk, because the Trust could not guarantee that agency

nurses’ skills were appropriate, regularly evaluated and updated. Continuity of

patient care was also undermined.

The leadership team agreed that it had a problem, but not how to solve it. The

situation affected all of them, but they lacked the information needed to make

a decision and no individual could find sufficient time to work out and

implement a satisfactory solution on behalf of the entire team.

Approach: The need for clear project management was addressed by bringing

in a secondee with direct responsibility for:

• analysing the situation;

I Now part of the Sherwood Forest Hospitals NHS Trust.

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• developing a solution;

• getting the solution approved; and

• implementing the change in a structured way, against a clear project plan.

She had the support of the chief executive, giving her access to the leadership

team and influence with other staff. She worked with other directors

individually to deal with their concerns. A nurse manager was released to work

with her part-time, providing clinical input and helping to build commitment

from clinical staff.

Impact: Kings Mill opted to set up and run its own nurse bank, with a

dedicated co-ordinator and computer support. As a result, the use of agency

nursing staff has been all but eliminated and the proportion of shifts covered

has significantly improved.

All bank nurses have access to training and regular performance appraisals.

Attending the Trust induction programme ensures that they are familiar with

the hospital’s layout and procedures. These changes should reduce some of the

clinical risks associated with temporary nursing staff.

Critical factors

• Focused attention

• Thorough planning and project management

• Chief executive support

• Clinical involvement

Few public sector organisations are over-endowed with strong

project managers. Project management skills are being developed, but

slowly, and many effective operational managers struggle when it

comes to seeing through the delivery of complex projects. The essential

skills are:

• being able to define the project and its boundaries in a way that is

deliverable;

• breaking it down into manageable modules of work with outputs

and deadlines;

• identifying the key cross links and dependencies;

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• building and supporting effective project teams;

• providing a structure for planning and monitoring progress;

• identifying and negotiating the resources needed;

• communicating with senior management and other related

projects;

• identifying and managing risk; and

• balancing clarity with flexibility.

Given a general shortage of these types of skills, planning a change

programme should include identifying where in your organisation the

strongest project management skills lie, how to deploy them in the

most critical places and how, over the longer term, to acquire and build

more.

Successful delivery needs rigorous planning, a systematic approach

and thorough execution, balanced with flexibility, whatever the scale of

the change being implemented [CASE STUDY 15]. In a major change

programme, it rarely makes sense for the senior management team to

control detailed project management. It is the role of the leadership

team to provide the freedom and resources for managers to deliver

their part of the changes, together with accountability for challenging

targets and deadlines, negotiated with and owned by those responsible

for delivering them. This enables more leadership time to be invested in

the critical selling and communications activities that are essential to

the success of the programme.

PROFESSIONALISM AND RELENTLESS RIGOUR TURN AROUND A FAILING

SCHOOL

Background: St George’s Catholic School in Maida Vale hit the headlines in

1995 when its headmaster was murdered outside the gates trying to protect

one of his pupils from a gang of truants. After three subsequent years of falling

standards and deteriorating discipline, St George’s was temporarily closed for

the safety of both pupils and staff. OFSTED put the school in special measures

and a new headmistress was brought out of retirement and given a year to

turn the school around.

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Approach: Staff helped to select a mission statement that reflected the

school’s underlying spiritual values. The mission was constantly reinforced and

applied as the lens through which any changes were tested, by asking “How

will this improve the children’s education or development?” The new

leadership brought many innovations, instilling a profound belief in the value

of every individual as well as making school a much more positive and fulfilling

experience. The energy and ideas were underpinned by a highly professional

and rigorous management approach, designed to deliver tangible

improvements within a very tight timescale. The mission statement was the

basis for establishing mutual expectations and clear lines of accountability.

Both staff and children were given clear responsibilities; they were encouraged

to deliver and their performance was actively monitored and fed back to them.

All teachers were expected to adopt a planned and structured approach to

lessons, with learning objectives and tasks written up at the start of every

lesson and reviewed at the end. Clear procedures were established for

preparing and reviewing lesson plans. Those who could or would not accept

the new systems moved on. Heads of year were expected to chase attendance

and every student group had targets with graphs of how they were actually

doing displayed for all the children to see, harnessing their competitive spirit

to drive the figures up.

Impact: Three months after the new leadership had taken over, OFSTED

reported significant progress, with most behaviour satisfactory, attendance

rising, working methods developing well and the school a more stimulating

and vibrant environment in which to learn. One year on from the introduction

of special measures, they were withdrawn on the basis of greatly improved

standards of teaching and learning, attendance approaching national averages

and an atmosphere of respect for authority and pride in the school with pupils

as positive, active learners.

Critical factors

• Strict, positive regime, with clear expectations, grounded on a strong set of

values

• Relentless rigour in implementation

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The balanced scorecardTo establish a framework for change and let the rest of the

organisation get on with making things happen, the top team needs a

shared high-level picture of the change journey and a view of the end

results. You also need the monitoring mechanisms – like the gauges on

complex equipment – that allow you to check that things are moving in

the right direction at roughly the speed you expect, and that there are

no major surprising adverse reactions appearing in the system. This

monitoring function can be performed by the balanced scorecard

[EXHIBIT 10].

THE BALANCED SCORECARD

The balanced scorecard can help organisations to manage performance.

Source: Audit Commission adaptation of Kaplan & Norton

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EXHIBIT 10

How the organisationmeets customers’ needs

and expectations

How to secure continuouslearning and improvement

in systems and people,and thus services

How to identify andmonitor key processes toprovide good quality and

effective services

How resources are usedeconomically and efficiently

to achieve the organisation’sobjectives

Internalmanagement

Tax payer/financial

Serviceuser

Vision and strategy

Continuousimprovement

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The balanced scorecard was developed by Kaplan and NortonI to

help organisations to translate their vision and strategy into a coherent

set of objectives, actions and performance measures, which they can use

to manage their performance. The approach looks at performance from

four inter-related dimensions: the customer or service user perspective;

internal business processes; continuous improvement; and financial

performance, and can be adapted to meet an organisation’s specific

needs.II A high-level scorecard should contain a mix of measures that,

together, provide a rounded picture of progress and performance

against the organisation’s strategic goals. These measures need to be

the best barometers of performance in the most critical areas, and offer

advanced warning of where things may be going wrong. That means

process (causal) as well as outcome indicators, and measures of internal

staff attitudes and morale as well as customer satisfaction. Further

down the organisation, managers need more detailed scorecards

covering their own areas of responsibility. The contents of these more

detailed scorecards should be linked clearly to the high-level scorecard.

In local government, scorecards can be constructed from a

combination of best value performance indicators (BVPIs) and locally

defined performance measures [CASE STUDY 16, overleaf]. The NHS PlanIII

is intended to result in more meaningful and better quality

performance information for the health service, with local bodies

constructing annual report cards to inform the public of their

performance. As more relevant and better quality data become

available, organisations will need to distinguish the information that

management needs to run the business from that aimed at the public

about the things that are important to them. Equally, as the visions

and strategies of local bodies change over time, incorporating, for

example, an increased emphasis on improving the life experiences of

I The Balanced Scorecard: Measures that Drive Performance, Kaplan and Norton,

1992.

II More information on the balanced scorecard can be found in The Measures of

Success: Developing a Balanced Scorecard to Measure Performance, Accounts

Commission, 1998.

III NHS Plan: A Plan for Investment, A Plan for Reform, Department of Health, 2000.

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local people, scorecards will need to evolve to reflect this. Guidance on

designing and reviewing performance information systems can be found

in a recent joint report by the National Audit Office, Audit Commission,

Cabinet Office, Office for National Statistics and HM Treasury.I

USING A BALANCED SCORECARD TO ASSESS PERFORMANCE

Background: Newcastle City Council is using the balanced scorecard to help

to provide a rounded picture of performance that is clearly linked to its

strategic objectives.

Approach: The council consulted internally about how the scorecard’s four

dimensions should be presented, and decided that categories for democratic

accountability, good stewardship, continuous improvement and organisational

development best suited its needs.

The concept was explained to staff at a series of seminars during 2000, and a

senior staff workshop developed a set of indicators that linked the council’s

objectives to the four dimensions of the scorecard, combining best value

performance indicators (BVPIs) and local performance measures.

The corporate team added to the indicators, producing a detailed set of

measures for assessing the performance of individual directorates. The high-

level scorecard was built from a subset of measures that related most closely

to the corporate vision, and uses eight indicators for organisational

development and five for each of the other quadrants.

A traffic light system highlights performance against scorecard targets – green

where a target has been achieved, yellow for good progress short of the target

and red where no progress is evident. The council plans to monitor targets

regularly and report performance quarterly to the corporate team. The first

assessment identified clear progress in three of the areas, but showed that

staff development activities had not yet delivered improvements, highlighting

this as an area needing attention.

I Choosing the Right Fabric: A Framework for Performance Information,

National Audit Office, Audit Commission, Cabinet Office, Office for National

Statistics and HM Treasury, 2001.

CASE STUDY 16

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Note: BVPI relates to best value performance indicators as specified by the DTLR.

Newcastle plans to adopt the balanced scorecard as its main organisational

performance measurement tool. Performance appraisals for the chief executive

and directors have been aligned with the scorecard, and some directorates

have made progress towards their own scorecards. There are plans to look

more closely at how measures at all levels of the organisation can link together

effectively, and to refine the framework with experience.

Impact: The council believes that developing the scorecard has:

• helped staff to see the big picture and devote attention to customer

satisfaction and staff development as well as to costs and service quality;

• broadened the set of indicators used, to include ‘soft’ local measures that

are key to longer-term service performance; and

• triggered productive discussions across the organisation about

measurement and improvement.

Democratic accountabilityHow much do stakeholders think thattheir views are taken into account?

Measures include:

Percentage of citizens satisfiedwith overall service provided by

their authority (BVPI)

Percentage of populationwho feel that their views can

influence service provision (Local)

Continuous improvementHow are services improving

on the ground?

Measures include:

General satisfaction ofresidents measured against

basket of BVPIs

Implementation of BV reviewprogramme and percentage of targets

reached in BV action plans (Local)

Organisational developmentAre staff being trained and supported

to do a good job?

Measures include:

The level of the CRE’s‘Standard for Local Government’ towhich the authority conforms (BVPI)

Percentage of staff who feelthat their work is valued (Local)

Good stewardshipAre the council’s services efficient?

Measures include:

Percentage of council taxcollected (BVPI)

Clear strategic links betweencorporate policy, asset management

and investment in services (Local)

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Critical factors

• Tailoring the scorecard to meet the organisation’s own specific needs

• Building buy-in by involving staff

• Comprehensive follow-through to include monitoring systems and

individual performance appraisal

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KEY POINTS

Strong project management is needed to deliver durable

change

• Significant change is complex, with many cross-functional

dependencies

• Delivery requires rigorous planning and thorough

execution, balanced with flexibility

• The leadership team is responsible for setting the

framework

– providing authority and resources

– setting challenging targets and deadlines

– tracking the change journey

– keeping focused on end results whilst listening to

progress on the ground

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7. Usingexternal helpMaking the best use of‘outsiders’

The role of regulation

Professional advice and support for change

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Making the best use of ‘outsiders’People from outside your organisation can help you on your

change journey. There are many organisations to choose from, and with

the current appetite for new and different types of ‘regulation’,

increasing numbers do not find it neccessary to wait for an invitation.

External input, whether voluntary or imposed, can play a useful role,

although there are clearly downsides, too. Any form of external

involvement, however valuable, places its own demands on the

organisation and needs to be managed in a conscious and constructive

way to extract the maximum benefit. Your organisation is most likely to

benefit if you already have an accurate picture of your own

performance and a clear sense of direction. This provides the basis for

developing a shared understanding of what needs to be done, so that

you can help to shape the external agency’s involvement from a

position of knowledge.

External input to change programmes can take several different

forms, including professional advice, peer or consultancy support,

regulatory scrutiny, and involvement from the community and

voluntary sectors. Each of these has a distinct role to play, but some of

the common benefits of external input include:

• an objective view of your performance, based on some combination

of new data or analysis, comparison with others and knowledge of

what works elsewhere;

• the ability to gather and feed back others’ views of your

organisation and the service it provides, including customers, staff

and other stakeholders, who may be more reluctant to report

directly to you in an open and honest way;

• professional experience and judgement coupled with a fresh

perspective; and

• a constructive challenge to implicit internal beliefs and assumptions.

Professional, peer and consultancy support may also provide:

• specific skills that are in short supply, which you may find difficult to

source directly or may need only for a specific short-term task or

time period, such as information technology;

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• technical advice and expertise in areas such as developing role

definitions and appraisal systems;

• coaching and counselling to key people to help them to overcome

barriers to change and develop vital skills such as feedback and

managing underperformance;

• impartial and expert facilitation of your own staff; and

• experience of supporting successful change.

The remainder of this section will focus on the role of regulation and

other professional advice and support for change programmes.

The role of regulationThe activities of regulators, including auditors and inspectors, offer

potential for constructive challenge. Both the prospect and the reality

of scrutiny can be a spur to change. At their best, inspectors and others

can provide your organisation and the public you serve with an

independent view of your services and the likelihood that you will

succeed in improving them. External reviewers can identify

opportunities for improvement and make recommendations to help

you to achieve better performance. Whether this is translated into

positive results is down to the way in which you respond

[CASE STUDY 17]. Evidence from many sectors demonstrates that imposed

change tends to create powerful resistance, so there are substantial

barriers to building durable change on the back of external

intervention. The key learning from organisations that have succeeded

in delivering sustained improvement with regulators as catalysts is the

need for the leadership team to own the messages and build support

for change, communicating and engaging with staff and stakeholders

throughout the process.

EXTERNAL SCRUTINY AS A SPUR TO CHANGE

Background: In 1999, Torfaen Social Services received a highly critical review

from a joint inspection by the Audit Commission and Social Services

Inspectorate for Wales (SSIW). The review team was particularly concerned that:

• some standards of professional practice were unacceptably poor,

particularly sometimes in children’s services;

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• social services were not well organised to plan and deliver much needed

service improvement and change, resulting in a sense of drift;

• there appeared to be a lack of leadership and direction from politicians

and management; and

• the relationship between front-line staff and managers was characterised

by mutual mistrust and lack of confidence.

Approach: The review highlighted deep-seated problems in Torfaen and

provided clear evidence that change was needed. Information came from a

survey of over 100 users and carers, interviews with front-line staff, managers,

partner organisations and politicians, observing management and practice on

the ground, and analysing 60 case files.

Local momentum for change began to build even during the review. A critical

turning point came when corporate and political leaders took ownership of the

issues in social services. New departmental leadership started the programme

of improvement. Since then, the Audit Commission and SSIW have monitored

progress closely with local staff, to:

• establish accountability for change at manager and team level;

• suggest clear priorities for improvement;

• guide the direction of change;

• provide targets; and

• keep up the momentum and praise success.

Using information and action points from the review as a starting point,

managers have focused on teams to get the ‘basics’ in place. They have

developed staff accountability for carefully prioritised, deliverable ‘chunks’ of

change, matched to their own interests and personal development needs.

Managers are better informed about what is going on at all levels. Torfaen is

developing better family support for children at risk and community-based

options for social care.

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Impact: The whole council now accepts the agenda for improvement and is

better organised to plan and deliver it. Senior staff at Torfaen describe the

changes following the review as “painful but positive”. A recent follow-up

review by the SSIW shows that social services continue to move in the right

direction and special follow-up monitoring is no longer considered necessary.

Critical factors

• External scrutiny, demonstrating strong evidence of poor services

• Management ownership of change programme

• Delegation with accountability

Auditors and inspectors are required to make judgements and

report on particular aspects of performance such as financial probity,

management and governance arrangements, service quality and

likelihood of improvement. Beyond these very specific responsibilities,

they are also in a position to provide valuable support and advice to

local bodies that are going through change, from their knowledge of

the organisation, their professional skills and experience, and their

exposure to good practice elsewhere. This role, however, must be

compatible with the overriding requirement for regulators to retain

their independence and objectivity in making judgements about the

performance of the body.

Professional advice and support for changeAny major change programme is likely to need expert help of one

kind or another. External advisers, including regulators, can play a

supportive role. The Audit Commission has published a guide to the use

of management consultants.I Many local bodies use their auditors to

review areas of potential for improvement, outside the core risk-based

audit, where they have relevant skills and expertise to offer. This

frequently includes diagnostic tools, objective analysis and comparative

performance data drawn from similar bodies [CASE STUDY 18, overleaf].

I Reaching the Peak: Getting Value for Money from Management Consultants,

Audit Commission/HMSO, 1994 – only available on the Audit Commission website.

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FIXING WHAT MATTERS TO USERS

Background: St Helens and Knowsley Trust Hospital used the results of a

review by the auditor of hospital catering as part of its ongoing drive to

develop services and improve patient satisfaction.

A patient survey highlighted dissatisfaction with the Trust’s meal service;

menus were considered to be repetitive and unpalatable. Menus were

repeated weekly on an assumption that the average length of stay at the Trust

was three days, but data showed that approximately 25 per cent of patient

stays at one unit exceeded one week and, at another unit, the majority of

patients were long-term.

Approach: Following the review, a multidisciplinary catering group was

formed with patient representatives, nursing and catering staff. Popular dishes,

identified by the survey, were introduced to replace some of the least popular

meals. The group also changed the menu from a one-week to a two-week cycle

and introduced a quarterly patient satisfaction survey to maintain the success

of the programme.

Impact: Results show that patients are very happy with the new service and

much prefer it to the old system.

Critical factors

• Understanding user preferences

• Help from external advisers

One of the most valuable things that external support can bring is

the potential for skills transfer, so that when experts move on, capacity

within your own organisation has increased. Both the Improvement and

Development Agency (IDeA) in local government and the

Modernisation Agency in the NHS explicitly define skills transfer as an

objective in their work with local organisations.

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KEY POINTS

External input can contribute to making change happen

• ‘Outsiders’ offer a range of skills and can play a wide

variety of roles

• Outside involvement adds most value when it results in

organisations building their own internal capacity

• Organisations with a clear sense of direction are better

placed to benefit from external input, even where it is

uninvited or unwelcome

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8. Buildingcapacity forcontinuousimprovementAiming for change-friendliness

Modernising infrastructure

Developing people

Incentive systems

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Aiming for change-friendlinessIf public services are to remain relevant, the pressure for change

will never diminish. In a world of continuous, rapid, unpredictable

change, public service organisations need to become change-friendly to

survive. This implies doing more than simply sustaining gains that are

made, though even this is challenging. It means getting better at

change through actually doing it. If change-friendliness is recognised as

an explicit goal from the start, it can be incorporated into the change

programme [CASE STUDY 19].

BUILDING AN INFORMATION PLATFORM FOR CHANGE

Background: The police estate has not always kept pace with changing

policing styles and public expectations of a modern, accessible service.

Outdated buildings in the wrong place, unsuited to supporting new policing

methods, can seriously hamper police effectiveness. The Government’s 1997

comprehensive spending review identified asset management as a potential

area for improved efficiency. Lack of management information about the

extent and nature of land and property holdings owned by police authorities

was a serious obstacle to a more strategic approach. The police service

therefore agreed to work with the Audit Commission to develop the

information base needed for major ongoing change.

Approach: A national studyI involving property managers from all 43 forces in

England and Wales developed a database of all property held by authorities. It

also developed a suite of around 30 cost, space and quality benchmarks that

forces could use to measure and compare performance.

The police property managers group agreed to take over the database after the

Audit Commission’s report was published. A benchmarking consultant,

specialising in estate management, was recruited to maintain the database,

handle updates and produce an annual report for members of the club.

I Action Stations: Improving Management of the Police Estate,


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CASE STUDY 19


He also advises them on how best to adjust data so forces can compare

performance with those with similar estate profiles. Individual forces can ask

for reports that identify high-cost or inefficient buildings or track trends within

and between command areas.

Impact: Forces are now using this information in a range of ways to deliver

improved performance. Northamptonshire Police, for example, has targeted £5

million worth of property as surplus and has an action plan for tackling sites

with high rateable values and/or high electricity costs. The force’s estates

strategy includes energy reduction targets that are calculated using benchmark

reports. It also has outside help to develop a model to identify underused space

in buildings.

All forces now have access to comprehensive information about their estates.

This is helping them to take a more active approach to managing assets,

releasing land for disposal and allowing reinvestment in priority facilities that

are better suited to the needs of modern policing.

Critical factors

• Ongoing facility for assessing performance built into the change

programme, to provide potential for future improvement

• Ownership from key stakeholders

Modernising infrastructureAny programme that leads to step-change in performance will

almost certainly come up against the limitations of the organisation,

placing new and different demands on decision-making processes,

information technology platforms, human resource functions, industrial

relations, technical, management and leadership skills, the way you

deal with customers and the information you use to run your business.

All these implications add time, cost and complexity, but by recognising

and responding to the challenges, you are equipping your organisation

to navigate future waves of change. Infrastructure effects are likely to

include the need for:

• increased delegation and faster decision-making processes;

• modernising outdated information and communications technology;

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• more flexible human resource policies and procedures to attract,

motivate, reward and retain the staff whom you need to deliver the

business [CASE STUDY 20];

• increased emphasis on people and skills development;

• better internal communications systems to keep staff informed and

maintain an ongoing constructive dialogue;

• more effective performance management systems;

• richer and more up-to-date management information, including

customer and community intelligence;

• front-line customer interfaces that are better able to respond to

queries and meet customers’ needs effectively;

• building and sharing knowledge between different parts of your

organisation and with partners;

• managing cross-cutting processes in a joined up way; and

• the ability to manage new kinds of relationships with unions and

external partners.

REDESIGNING RECRUITMENT TO SERVE THE NEW BUSINESS

Background: Older people prefer to live in their own homes rather than in

hospital or in long-stay residential care. Dudley Social Services is responding to

this challenge by refocusing its services to support people living at home and

reducing the need for residential care (as described in case study 5).

This has meant implementing a wide range of new initiatives, requiring many

small changes to supporting processes as well as transforming direct care. One

critical step was the recruitment of a new wave of home care staff, who better

reflected the local community and could offer the practical skills and life

experiences to meet the demands of the new role.

Approach: Given the nature of the local population, Dudley believed that the

caring, ‘can do’ staff they needed ought to be available, but encouraging

enough people to apply for the new posts presented a challenge. The skills

involved in conventional recruitment procedures are very different from what

is required for good home care staff. So the directorate took a fresh look at its

CASE STUDY 20

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recruitment process, launching high-profile local advertising campaigns for

home care assistants, and using popular local venues and media. Staff at all

levels of the directorate shared a big commitment to several open days. They

took over whole training centres, with people from community services on

hand to talk to and answer questions, help applicants fill in forms on the spot

and proceed to interviews the same day. Applicants “did not have time to

worry about an interview” and found the event “very helpful”.

Impact: The success of the new approach is measurable, with a one-day event

delivering 50 completed interviews and 24 successful appointments. Dudley

now has a recruitment process that enables it to attract and employ people

with the right skills to meet the future needs of its developing home care

service.

Critical factors

• Redesigning a key support process to enable ongoing service improvement

• Willingness to experiment

One capability that is currently very much in the spotlight is the

ability to build new kinds of relationship – both internally and

externally, between different parts of your own organisation, with

voluntary sector, commercial and public service partners, and with

bodies that represent your staff. Modern approaches to performance

management, which allow for greater freedom alongside clear

accountability for performance, imply new types of relationship

between the centre and operational units. Organisations also need to

understand their own processes from the point of view of the customer

in order to manage them in a joined up way, as they cross traditional

boundaries. Building effective partnerships with other bodies is also a

key capability that can emerge from a change programme

[CASE STUDY 21, overleaf]. As partnerships become an increasingly

important feature of the public services scene, you may find an Audit

Commission management paperI helpful.

I A Fruitful Partnership: Effective Partnership Working, Audit Commission, 1998.

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BUILDING A BASE FOR CONTINUOUS IMPROVEMENT

Background: Derbyshire Police used best value processes to review its

services to people experiencing domestic violence and child abuse. The team

drew on a wide range of internal and external information, including activity

and outcome data; surveys of officers, other agencies and people who had

experienced domestic violence; and benchmarking against other forces.

Before the review, each division had separate domestic violence and child

protection units, generally with different line managers and locations. The

existing structures and working practices caused problems such as:

• mismatches between staffing levels and demand in different parts of the

force area, leading to variable service;

• specialist domestic violence officers undertaking tasks that could be

handled more efficiently by civilian support staff;

• a lack of intelligence-sharing between domestic violence and child

protection staff;

• inadequate line management support within divisions due to pressure on

senior time; and

• underinvestment in building partnerships with other agencies.

Approach: The review team recommended that the domestic violence and

child protection units be merged into four family units, based on divisions but

with centralised line management from headquarters. Child protection staffing

levels were reduced and administrative tasks civilianised so that domestic

violence officers were freed up for proactive work and special projects. These

changes provided:

• improved service for users, increasing force-wide capacity and flexibility at

no extra cost;

• better management and support for staff with demanding specialist roles;

and

• more effective networking with other agencies.

Senior level support from the best value board (which included the chief

constable and deputy leader of the police authority) meant that changes could

CASE STUDY 21

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be implemented very quickly – approval for the restructuring was given in

August 1999, and the family units were set up in October and staff redeployed

by the beginning of January 2000.

Impact: Activity data for the first year show that fewer child protection officers

have handled a larger number of cases without increased overtime. Officer

morale has improved: “We had low status before…now it’s easier to get

things done” (constable working in family unit), and information on families is

more readily shared. Improved support has given the force capacity to

introduce initiatives such as the Killingbeck domestic violence model, which

grades responses to incidents, targeting resources where they are most needed

and likely to be effective. It is early days for the project, but already “we’ve had

lots of praise from victims” (DCI manager of family unit). New partnerships

have been established with the health sector, including a domestic violence

referral scheme with a major A&E department. “Domestic violence victims do

often open up to us and tell us the truth, but before we lacked the skills and

knowledge to deal with it. Now we have procedures in place…I can’t stress

how much it’s helped us” (manager, A&E department).

Critical factors

• Thorough, objective review of current performance

• Visible and committed senior level support

• Targeting resources in line with user needs

• Creating a basis for partnerships with other agencies

Developing peopleEffective public services require good leadership at many levels, not

just at the very top. Although identifying and nurturing leadership

talent is a key responsibility of senior teams, it can be a casualty of the

pressures of operational survival. Change programmes can be a

powerful way to extend skills and to develop future leaders by creating

new leadership roles outside the formal organisational structure.

Highlighting leadership development at the outset as a desirable

outcome from the change increases the chances of achieving it. By their

nature temporary, team and project leadership tasks can be assigned to

targeted individuals without all the formality of conventional

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appointment procedures (although clearly this should not be a mandate

for arbitrary selection or discrimination).

Giving able and committed people a chance to prove their capacity

in demanding change roles can be highly motivating and benefit both

the individual and the organisation. The key to making this work is:

• agreeing a set of stretching targets;

• providing the authority and resources to do the job;

• offering appropriate support; and

• recognising effort and achievement and aligning reward systems

with the goals and values that motivate staff.

Incentive systemsGiving people ownership of performance targets, supported by

appropriate incentives and rewards, is key to managing performance

and individual behaviour with the direction of the change programme.

Clearly this can only work where staff accept the targets assigned to

them and have the authority and resources to deliver. A study by the

Public Management FoundationI shows that public sector managers

have different motivations from their private sector counterparts,

distinguishing between a public sector ethos driven by the prospect of

benefits for service users and the community, and a private sector focus

on internal organisational goals and personal reward. It cautions

against importing systems of reward and incentives from other sectors,

particularly models that place heavy reliance on financial incentives.

Instead, it encourages organisations to find out more about what

motivates their staff, and review their performance assessment systems

to reflect these factors.

I Wasted Values: Harnessing the Commitment of Public Managers, Public

Management Foundation, 1999.

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KEY POINTS

Step-change can be used to build the capacity for continuous

improvement

• Organisations get better at change by doing it

• Major change programmes impact on core systems such as

information technology, human resources and performance

management – modernising these in line with the overall

vision provides a platform for ongoing future change

• Change programmes are a powerful way to develop the

leaders of the future

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9. Conclusion

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Managing change is one of the greatest challenges faced by

leadership teams in the modern world. Public service leaders are

struggling with conflicting demands and unrealistic expectations from

politicians, the public and their own staff. Meanwhile, the external

environment is changing faster and less predictably than ever. In most

parts of the public sector, incremental gains will be insufficient to satisfy

political and public expectations. This combination of conditions – the

need for step-gains in performance in an increasingly uncertain world –

calls for the most demanding type of change. Leadership teams that set

out to create the capability for continuous improvement through an

initial step-change in performance are well placed to steer their

organisations through the messy and difficult business of change. There

is certainly no magic formula, but there is a body of useful experience

about what works, drawn from both public and private sectors, that can

be of value to top management in improving services today and

building long-term capacity for the future.

The Audit Commission is very interested to learn more about the

experiences of public service leaders who manage change. In deepening

its understanding of change management issues, the Commission hopes

to make a continuing contribution to practice in this field, and also to

refine and develop its own approaches to supporting public service

improvement. If you have any feedback on this paper, or would like to

share your own organisation’s experience of the change process, please

contact the Commission’s Performance Development Directorate by

letter, telephone or email to [email protected].

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Appendix

AcknowledgementsThe project was supported by an advisory group which provided

invaluable assistance. The Commission is also grateful to local services

and auditors and inspectors who helped us to develop case studies, and

to those organisations and individuals who offered their advice and

comments on drafts of the report. As always, the responsibility for the

content of the report rests with the Commission alone.

Advisory group members

Helen Dawson Director of Learning and Development

Improvement and Development Agency

Nigel Edwards Policy Director

NHS Confederation

Professor Ewan Ferlie Research Director

Imperial College Management School

Dr Naomi Fulop Director

National Co-ordinating Centre for

NHS Service Delivery and Organisation

Research & Development

Cynthia Griffin Director of Best Practice

Improvement and Development Agency

(now Executive Director, Customer Access

and Services, London Borough of Havering)

Maggie Jones Policy Practice and Development Manager

Joseph Rowntree Foundation

Matthew Warburton Head of Strategy

Local Government Association

The team The project was directed by Joanne Shaw. The project team comprised

Cressy Bridgeman (project manager), Karen Naya and Julie O’Donnell.

The report was designed by Gareth Sully.

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ReferencesNHS Plan: A Plan for Investment, A Plan for Reform, Department of

Health, 2000.

Organisational Change: A review for managers, professionals and

researchers, Valerie Iles and Kim Sutherland, National Co-ordinating

Centre for NHS Service Delivery and Organisation, 2001.

Transforming the Organisation: New approaches to management,

measurement and leadership, Keith Ruddle and David Feeny,

Templeton College, 1997.

Strengthening Leadership in the Public Sector, Performance and

Innovation Unit, Cabinet Office, 2001.

The Coming of Age: Improving Care Services for Elderly People,


Trading Places: The Supply and Allocation of School Places,


Listen Up: Effective Community Consultation, Audit Commission, 1999.

The Change Monster: The human forces that fuel or foil corporate

transformation and change, Jeanie Daniel Duck, 2001.

First Class Delivery: Improving Delivery Services in England and Wales,


The Balanced Scorecard – Measures that Drive Performance,

Robert S. Kaplan and David P. Norton, Harvard Business Review, 1992.

The Measures of Success: Developing a Balanced Scorecard to Measure

Performance, Accounts Commission, 1998.

Choosing the Right Fabric: A Framework for Performance Information,

National Audit Office, Audit Commission, Cabinet Office, Office for

National Statistics and HM Treasury, 2001.

Reaching the Peak: Getting Value for Money from Management

Consultants, Audit Commission/HMSO, 1994 – only available on the

Audit Commission website.

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Action Stations: Improving Management of the Police Estate,


A Fruitful Partnership: Effective Partnership Working, Audit

Commission, 1998.

Wasted Values: Harnessing the Commitment of Public Managers,

Jane Steele, Public Management Foundation, 1999.

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If you have any feedback on this paper, or would like to shareyour own organisation's experience of the change process,please contact the Commission's Performance DevelopmentDirectorate by letter, telephone or email to:

[email protected]

To obtain more copies of Change Here!, or order a copy of thelatest Audit Commission publications catalogue, pleasetelephone 0800 502030, or write to Audit CommissionPublications, PO Box 99, Wetherby LS23 7JA.

The Change Here! interactive web-based tool is available free at:

www.audit-commission.gov.uk/changehere


Audit Commission1 Vincent Square, London SW1P 2PNT 020 7878 1212 F 020 7976 6187www.audit-commission.gov.uk

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